First Name:	Middle Initial:
Last Name:
Prefix/Title:	Dr. Mr. Ms.
Position:
District:
School:
Office Mailing Address:
Office City:
Office Zip:
Office Phone:
Office Fax:
E-mail:	* Required
Home Address:
Home City:
Home Zip:
Home Phone:
Mobile Phone:
Previous Cadre:

Payment Options: Registration Fee: $500

Check (Note: I have printed this form and mailed with my check to 154 Consumer Lane, Frankfort, KY 40601)

Purchase Order #

Invoice my district after July 1, 2010

Return to Top

Wayne Young, Executive Director
Rhonda Caldwell, Deputy Director
Clyde Caudill, Legislative Liaison
Shirley LaFavers, Director of Professional Development
Wanda Darland, Communications Specialist

152 Consumer Lane
Frankfort, KY 40601
(800) 928-KASA or
(502) 875-3411

Fax (502) 875-4634