Membership Form

1. Fill out the form below. RED FIELDS ARE REQUIRED
2. Click the submit form button.
3. You should receive an e-mail confirmation once registration is complete. Please print your receipt and mail with check for dues.
4. Mail check for dues payable to:
   Kanawha City Community Association, Inc
   Post Office Box 4423
   Charleston, WV 25364
5. Membership is not active until payment is received.

* If you are already a member choose Renewal and update all information.
If you have never been a member and would like to become a member choose New Member.

*ApplicationType: New Member OR Renewal
Full Name:
Address 1:
Address 2:
City: State: Zip:
Telephone:	ex. 304-555-55550
Email:
If you are applying for a Business or Non-Profit membership please designate below the name or office of the representative authorized to act for and on behalf of the entity.
Rep Name:
Office/Position:
Rep Phone #
Membership Type:	Business $100 Non-Profit Organization $50 Family (2 voting members) $25 Individual $15
Yearly Due For:	July 1, through June 30,
Date Submitted:
In applying for Membership I attest that I am eligible to become a Member of the KCCA, as setout in Article III of the By-Law, and hereby subscribe to the goals and objectives of the KCCA in accordance with its By-Laws.
Membership is not active until payment is received. Mail Checks Payable to Kanawha City Community Association, Inc., PO Box 4423, Charleston, WV 25364.

Kanawha City Community Association, Inc. | Post Office Box 4423 Charleston, WV 25364 | info@kanawhacity.org