KNPS Membership Form "*" indicates required fields Email* Name* First Last Address* Street Address Address Line 2 City State Zip Code CountyIf you live in Kentucky could please provide us with the county in which you live. HiddenRegion Phone (Optional)Is this a New Membership or a Renewal?* New Member Renewal For How Many Years?*Please select how many years of membership you would like. Please note that with a 3 year membership you will receive a 10% discount on your membership.The membership levels do not appear until you make a selection here. If you are wanting to join at the Lifetime level, just select One Year. One Year Two Years Three Years HiddenPaid Thru HiddenRenewal Date HiddenYear Joined HiddenMembership Type Membership Levels and Cost for a 1 Year Membership* Student - $10 Individual - $15 Family - $25 Sustaining - $50 Institutional - $100 Lifetime - $200 Membership Levels and Cost for a 2 Year Membership* Student - $20 Individual - $30 Family - $50 Sustaining - $100 Institutional - $200 Lifetime - $200 Membership Levels and Cost for a 3 Year Membership* Student - $27 Individual - $40 Family - $67 Sustaining - $145 Institutional - $270 Lifetime - $200 I would like to help out KNPS with (check all that apply): Leadership & Organization Writing Articles Leading Field Trips Organizing Events Membership & Fundraising Website/Social Media Outreach & Education DonationIf you would like to make an additional donation to KNPS, please just enter the amount here. Memberships and donations are tax deductible. Institution or OrganizationRequired for Institutional membership, optional for others Additional Lady Slipper RecipientsIf you have additional family or friends who would like to receive our e-newsletter, The Lady Slipper please provide their names and email addresses below. You can click on the plus sign at the end of the row to add more names.NameEmail Address Add RemoveTotal (Membership+Donation) PaymentCredit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name NameThis field is for validation purposes and should be left unchanged. Δ Share or Print this pageFacebookPrint
