Household Member #1 *

First Name

Last Name

Cell Phone

(###)

###

####

Household Member #2

First Name

Last Name

Cell Phone

(###)

###

####

Kabekona Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Kabekona Land Line (if applicable)

(###)

###

####

Preferred Mailing Address (if not a full time Kabekona resident)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Land Line (if applicable)

(###)

###

####

What is your preferred method of phone contact?

Cell Phone

Land Line

Do we have your permission to print the above information in the KLA directory distributed in hard copy form to our members?

Yes

No

Do we have your permission to provide the above information in a KLA directory distributed electronically either online or via email to our members?

Yes

No

Are you interested in getting involved with KLA events/projects?

Yes

No

Areas of interest for participation or volunteering

KLA Picnic

KLA Coffees

Women's Bookclub

Men's Breakfasts

KLA Board

KLF Board

Membership Date Management

Newletter

Photo Gallery Contributions

Other