Membership Application

Annual Memberships run from Jan-Dec of each year
Annual Fees are due by the end of February

Membership Level:

Regular - $35

Student - $15

Retired - $15

First Name: Last Name: Email: Home Phone: Home Address: City: State: County: Zip: -

Demographic Information

The following information is optional. We encourage you to complete this information as it is used for data collection to report to grant funders and assess KAIMH services. This information is confidential and will never be shared with personally identifible information.