Sign-up

Membership Type *

KAHQ membership runs for one calendar year. To ensure a full year of membership, dues must be paid in January. If you join after October 1, the membership will carry over through December of the following year.

State and Regional Members Only ($45.00)
KAHQ Regional Members; the $45 includes state dues of $35 and region dues of $10.

Payment System *

Online Credit Card Pay by Skipjack Financial Services

Offline Payment Offline Payment

Your Name *

Your First & Last name

Your E-Mail Address *

A confirmation email will be sent
to you at this address

Choose a Login Name (User ID) *

It must be 5 or more characters in length and may
only contain small letters, numbers, and
the underscore '_'

check for uniqueness

Choose a Password *

Must be 6 or more characters

Confirm your password *

Enter password again

License No

Work Title

Employer

Phone Number

Fax

Fax Number

NAHQ Member

Yes
No

CPHQ Member

Yes
No

Mailing Address

Work
Home

I'd like to volunteer

I am interested in serving on a leadership team of KAHQ

Membership
Publications
Nominating
Program
By Laws

Region

Kentucky Region

ADDRESS INFO

Street *

City *

State *

ZIP *

Country *