ONLINE REGISTRATION FORM

KUBA MEMBERSHIP DUES
   -your one year membership starts when your application & fee are accepted and it expires one calendar year after that date.

Individual Rates = $25
Not-for- Profit = $50
Small Business Rate ( less than 10 employees) = $100
Business Rate (10 or more employees) = $200
Please PRINT THIS PDF form and send in payment to: KUBA at: P.O. Box 3602, Kingston, New York 12402

Business Name
Contact Name
Mailing Address
Street Address
City
State
Zipcode
Phone
Fax
Email
Website