|
Kansas Bail Agents Association |
|
"Bail Agents Assure Justice" |
|
KANSAS BAIL AGENTS ASSOCIATION 617 N. Central Ave. - Parsons, Kansas 67357 Phone: 620.421.5566 – Fax 620.421.3386 KBAA MEMBERSHIP APPLICATION
Fiscal Year January 1, 2008- December 31, 2008 (Please Type or Print – Application Must Be Filled out Completely)
NAME: _____________________________________________________________________________
ADDRESS: __________________________________________________________________________
CITY: _______________________________ STATE: ______________________ ZIP: ____________
KANSAS DEPARTMENT OF INSURANCE LICENSE #: _____________________________________
COMPANY NAME: ___________________________________________________________________
COMPANY ADDRESS: ______________________________________________________________
CITY: ________________________________ STATE: ______________________ ZIP: __________
PHONE NUMBERS: Office: __________________________Home: _____________________________
Fax: ____________________________ Email: ____________________________
TYPE MEMBERSHIP APPLIED FOR:
[] VOTING MEMBER - Fee $50.00 entitles member to one vote and full membership privileges. Licensed or approved Kansas Resident Bail Agent only.
[] ASSOCIATE MEMBER – Fee $120.00 Non-Voting membership, who are not qualified under Article 3 Sec. 2 of Bylaws, entitles membership for association meetings, functions, and may serve on committees.
[] HONORARY MEMBER – Only Board of Directors may confer this class of membership.
A COMPLETE APPLICATION IS NEEDED FOR EACH MEMBER I agree to abide by the By-Laws and Code of Ethics of the association.
_____________________________________________________________________________________ Applicant Printed Name Date Applicant Signature
Notice: All Applications must be approved by a majority vote of the Board of directors |
|
2008 Proposed Membership Application |