KPB Membership Enrollment Form
Today's Date [mm/dd/yyy]
First Name
Last Name
Organization (if applicable)
Address Line 1
Address Line 2
City
State
Zip
E-mail
Phone
Annual Membership Level
Student/Youth - $5
Individual/Family - $15
Business/Community Org'n - $25
Partnership Level
Friend - $100
Supporter - $250
Patron - $500
Benefactor - $1,000 & above
KPB Area(s) of Interest
Adopt-A-Road
Business Recycling
Education
Beautification
Public Relations
Litter Index
Green Ribbon
Organize Events
Comments
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