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Membership Application

KIPCUG has 4 types of membership:

  1. Individual or Single Membership - $40.00 per year
  2. Family Membership - Husband and Wife - $55.00 per year
  3. Full-time Student Membership - $20.00 per year
  4. Corporate Membership - $160.00 per year
    1. Includes up to 4 membership cards
    2. Includes listing on our web site
    3. Includes advertisements in our magazine

KIPCUG Membership Form is available below: (or download our off-line version) Our membership form has 2 sections. The form below will be submitted to our Membership Director for processing and mailing your Membership Card to you. The second section will send your secure payment information to our Treasurer.

Thank you for joining KIPCUG!

Membership Type:
Name:
Address:
City:    
State: xx    
Zip:   xxxxx-xxxx (Please enter last 4 digits if known)
E-Mail:
Home Phone: xxx-xxx-xxxx    Work Phone: 
Referred by: (If applicable: Person that recommended KIPCUG Membership to you.  For each referral, the KIPCUG Member receives 1 free month.)
Comments:
Questions:

Note: When asked for your "Membership Number" on the next page, enter the word "New"
We use the same 128-bit encrypted form for membership renewals also.

  
 

 

 
     
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