KYASRO - Membership Application

First Name

Last Name

Title

Agency/School District
If you are in law enforcement,
please enter your agency, otherwise,
please enter your school district.

Address

City

State

Zip code

Home Phone

Work Phone

E-mail address

Your role in school:

School Resource Officer Special Law Enforcement Officer Superintendent School Board Member School District Official Principal Assistant Principal Guidance Counselor Teacher Other*

*Other
If other, please enter title here

Payment
By clicking 'Submit Form' below,
you agree to send a check or
money order payable to KYASRO
for $30 for a one year membership
to the following address:

KYASRO
C/O Roy E. Black
Treasurer
PO Box 382
Fort Knox, KY 40121

Click for YES

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