Kansas Custom Knifemaker’s Association
Membership Application

Annual membership fee is $30.00, which includes listing of your contact information and web site address
on the “Members” page of the KCKA web site.  The annual membership period is January 1st through
December 31st.  Membership dues paid after October 1st cover the following calendar year.  Membership
renewals must be paid by March 1st to avoid cancellation of membership.

Please print and complete this form and mail it to the address below with a check or money order for $30.00
payable to KCKA:

KCKA
5682 94th street
Meriden, KS 66512

Your information below will be held confidential and only used by the KCKA to contact you concerning
important membership news and business.

Name: ______________________________________________________________

Street Address: _______________________________________________________

City: ______________________________State: _______Zip Code: ______________

E-mail Address: _______________________________________________________

Web Site: ____________________________________________________________

Phone Number: _______________________________________________________


Please fill out the information below to be placed on the “Members” page of the KCKA web site, if different
than the information provided above.

______Same as above.       ______Do not put my information on the KCKA web site.

Name: ______________________________________________________________

Street Address: _______________________________________________________

City: ______________________________State: _______Zip Code: ______________

E-mail Address: _______________________________________________________

Phone Number: _______________________________________________________

Web Site: ____________________________________________________________

Interest in knives; example: Stock removal maker, forged knife maker, collector, leather worker.

____________________________________________________________________