KCSEA New Membership Form

Question Title

* 1. Information:

Name *

Office/Company

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Country *

Email Address *

Phone Number *

Question Title

* 2. Years of Service in Child Support:

Question Title

* 3. Please check one:

KCSEA New Membership Only (One Year): $15

KCSEA Donation: $15

You can submit your payment online, send a check, or send a money order. If you are sending a check or money order please include the member's name on the note line. Checks/Money Orders made payable to:

KCSEA
c/o Jessica Dieckhoff, Treasurer
1015 N. Purdom Street
Olathe, KS 66061

Refund Policy: There will be no refunds.

Insufficient Check Policy: In the event an insufficient check is received, the check must be made good with a money order or case. In addition, that individual must pay by money order or cash for the following year's membership and conference registration.