Associate Membership Application
Kansas State Association of Health Underwriters
Name:Designations:
Designations:Company
Company Address:City/State/Zip:
City/State/Zip:Home Address: City/State/Zip:
City/State/Zip:Email:Telephone:Fax:
Telephone:Fax:Referred by:
Membership Dues:
If Agency membership, you may list up to 4 additional members:
Enrollment is not complete until you click Submit button at bottom of form.
Name:Email:
Email:Name:Email:
Email:Name:Email:
Email:Name:Email:
Email:*By becoming a member of KAHU, you give permission for the KAHU office to fax or E-mail pertinent educational and legislative membership information to KAHU and the affiliated chapters. I understand that I have the option to be removed from E-mails and faxes as I receive them and will notify the KAHU office if I choose this option.
Please indicate your area(s) of practice:
Yes, I would be interested in someone contacting me about getting involved with my local chapter!
The Kansas Association of Health Underwriters (KAHU)
2525 NW Topeka Blvd., Topeka, KS 66617, 785-291-0200 Direct, 785-291-0202 Fax
Email: info@kahuks.org
