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Online Membership Form

KNPS Membership Form

"*" indicates required fields

Email*

Name*

First Last

Address*

Street Address Address Line 2 City State Zip Code

County

If you live in Kentucky could please provide us with the county in which you live.

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Region

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

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Paid Thru

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Renewal Date

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Year Joined

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Membership 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

Donation

If you would like to make an additional donation to KNPS, please just enter the amount here. Memberships and donations are tax deductible.

Institution or Organization

Required for Institutional membership, optional for others

Additional Lady Slipper Recipients

If 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.

Name

Email Address

Total (Membership+Donation)

Payment

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number Expiration Date Security Code Cardholder Name

Phone

This field is for validation purposes and should be left unchanged.

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