KCSS Membership Form
Tell us a little about yourself for our membership records.
First Name: *
Your answer
Last Name: *
Your answer
Your preferred e-mail: *
Your answer
Secondary E-mail
Not required, but will help us if we get kick backs because of filters, etc.
Your answer
What grade(s) do you teach?
What is your position?
What subject(s) do you teach?
School District Number
(leave blank if not applicable)
Your answer
School District, Diocese, University, etc. Name
Your answer
School / Building Name
Your answer
School / Building Street Address
Your answer
School / Building City
Your answer
School / Building Zip Code
Your answer
Home Street Address
Your answer
Home City
Your answer
Home Zip Code
Your answer
Preferred Phone Number
format: 620-555-1234
Your answer
Opt in to KCSS Text Message program?
(You will receive updates and messages from KCSS using Remind software.)
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