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2012 Application for KYSITE Membership

Thank you for your interest in the Kentucky Section of ITE (KYSITE). Our yearly Section dues for all members are $15. Your Section dues will help cover:

• Meeting Expenses;
• Member Correspondence; and
• Other costs necessary to serve our members.

In addition, $5 of the dues will provide scholarship opportunities for Kentucky engineering students.

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* 1. Basic Information

Name: *

Company: *

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Country: *

Email Address: *

Phone Number: *

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* 2. Additional Information (Title/ Certifications)

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* 3. Are you interested in obtaining information about International ITE membership?

Please use the Paypal link below to make the payment.