Kansas Authors Club

Email Address *

Please print my email in the yearbook. *

Type of Membership *

First Name (or business & library member contact) *

Middle Name

Last Name *

Family Memberships - list individual names here

Example: Jimmy, Rosalynn, Donnel, Jack, James, Amy

Business (for business memberships only)

Library (for library memberships only)

Mailing Address *

Street Address Address Line 2 City State/Prov/Region Postal/Zip Country

Please print my street address in the yearbook. *

Only city will be listed if NO is selected.

Phone Number *

( ) -

Please print my phone number in the yearbook. *

Yearbook Preference *

County of Residence or Association *

District

How did you hear about KAC?

If new member, who recommended you?

website (this will be posted to our member pages)

Kansas Authors Club Registration Form