Kentucky Leadership Academy Alumni

Registration 2008-09

First Name:	Middle Initial:
Last Name:
Prefix/Title:	Dr. Mr. Ms.
Position:
District:
School:
Office Mailing Address:
Office City:
Office Zip:
Office Phone:
Office Fax:
E-mail:	* Required
Home Address:
Home City:
Home Zip:
Home Phone:
Previous Cadre:

Registration Fee: KASA Members $500 / Non Members $600

*Districts sending 5 or more people can join for $500 per person

My district is sending 5 or more participants

Payment Options:

Check (Note: I have printed this form and mailed with my check to 154 Consumer Lane, Frankfort, KY 40601)

Purchase Order #

Return to Top

Wayne Young, Executive Director
Rhonda Caldwell, Deputy Director
Clyde Caudill, Legislative Liaison
Shirley LaFavers, Director of Professional Development
Wanda Darland, Communications Specialist

152 Consumer Lane
Frankfort, KY 40601
(800) 928-KASA or
(502) 875-3411

Fax (502) 875-4634