JOIN THE KANSAS PEST CONTROL ASSOCIATION

212 SW 8th Avenue Suite 202 Topeka, KS 66603

785.271.9220 Fax: 785.233.5659 kansaspest@yahoo.com

Name ___________________________________________________________________________________

Company Name ___________________________________________________________________________

Mailing Address ___________________________________________________________________________

City __________________________________________ State __________________________ Zip ________

Phone _____________________________________ Email ________________________________________

Website _________________________________________________________________________________

NPMA Dues*—mark membership category

Runs concurrent with KPCA Membership

$0-400,000 $185 ______

$400,001—500,000 $375 ______

$500,001-600,000 $450 ______

$600,001-700,000 $525 ______

$700,001-800,000 $600 ______

$800,001-900,000 $675 ______

$900,001-1,000,000 $750 ______

$1,000,001-1,500,000 $935 ______

$1,500,000-2,000,000 $1125 ______

$2,000,001—2,500,000 $1315 ______

$2,500,001-3,000,000 $1500 ______

$3,000,001-3,500,000 $1690 ______

$3,500,001-4,000,000 $1875 ______

$4,500,001-5,000,000 $2065 ______

$5,000,001-6,000,000 $2625 ______

KPCA DUES __________ + NPMA DUES __________ = TOTAL DUES $ _____________

*NPMA Dues set by the National Pest Management Association. KPCA does not record or check sales category selected.

KPCA DUES — mark membership category

Memberships are annual; July 1- June 30

Active Membership $180 ______

Associate Membership $350 ______

Leader Membership $500 ______

Partner Membership $1,500 ______

Employee/Retiree $40 ______

Registered Technician $20 ______

Membership category benefits on reverse

Payment Options on Reverse Side

Enclosed is a check _____

Pay By Credit/Debit Card ____Visa ____ MasterCard ____American Express ____Discover

Name on Card ___________________________________________________________________Sec. Code_________

Card Number ________________________________________________________________Exp. Date ____________

Payment Options 212 SW 8th Avenue Suite 202 Topeka, KS 66603

785.271.9220 Fax: 785.233.5659 kansaspest@yahoo.com

Option 1: Pay in Full

Option 2: Installment Payments

____ Please bill the following credit/debit card in 4 equal installments.

Card will be billed: July, October, January, April

____Visa ____ MasterCard ____American Express ____Discover

Name on Card ___________________________________________________________________Sec. Code_________

Card Number ________________________________________________________________Exp. Date ____________

Option 3: Online

Visit: www.kpcamembership2020.eventbrite.com

to join or renew online

AUTO RENEWAL

Sign Below if you would like your membership to be automatically renewed using the credit/debit card or bank account you have provided for future membership years. You will always be notified of renewal and receive a receipt. You may cancel auto renewal at any time by contacting our offices at 785-271-9220 or kansaspest@yahoo.com. Auto Renewal only applies to your membership and does not permit KPCA to bill you for any other services or purchases.

Yes, Please Sign Me Up For Auto-Renewal

Signature _________________________________________________________ Date__________________

Option 4: ACH Payment

Check Payment Option: ____ Full Payment ____ Installment Payments

Account Routing Number ___________________________________________________________________

Checking Account Number __________________________________________________________________

Please Enclose a Voided Check for ACH Payment Option

Active Membership

Membership with all voting rights and benefits of membership, including discounted rates to events.

Associate Membership

All benefits of membership plus 1 registration to the KPCA Annual Conference in Kansas City AND Wichita; free attendance for all employees at designated regional training & education events.

Leader Membership

All benefits of membership plus 2 registrations to the KPCA Annual Conference in Kansas City OR Wichita; free attendance for all employees at designated regional training and education events; special recognition on website.

Partner Membership

All benefits of membership plus 2 registrations to the KPCA Annual Conference in Kansas City AND 2 registrations to the Annual Conference in Wichita; free attendance for all employees at designated regional raining & education event; special recognition on website and e-newsletters; special recognition in the Annual Conference program; 1 registration to one session of the Master Tech Program.

Employee Membership/Retirees

This is for a company that joins and would like additional individuals within the company to have certain rights, receive information directly, and participate on the Board of Directors and Committees. Often utilized by companies with multiple owners, family members within the company or additional management and/or managers. Any former pest professional who is retired but would still like to be active in helping the industry can also join at this rate.

Registered Technician Membership

Any registered technician is eligible to join at this rate. Benefits Include: Printed and digital industry communications; Listing in the Directory; Membership certificate; Networking opportunities; Opportunities for recognition through our Annual Awards Programs; Opportunity to participate on committees; Discounts to events; and other membership benefits

MEMBER BENEFITS 212 SW 8th Avenue Suite 202 Topeka, KS 66603

785.271.9220 Fax: 785.233.5659 kansaspest@yahoo.com

If you have question about

membership or anything else,

contact us:

785-271-9220

kansaspest@yahoo.com