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Download PDF version of membership application

Complete form and send to KASA.

(502) 875-4634

87 C. Michael Davenport Blvd.
Frankfort, KY 40601

Call the KASA office at
(800) 928-KASA



2017-2018 Membership Application


        Member Information

New Member   or   Renewal

Last Name:     
First Name:  
Middle Name: 
Title:  Dr.     Mr.    Ms. 
Home Email: 
Home Telephone:
Cell Phone: 
Home Address:  
Birth month: 
Birth day: 
Office Telephone:
Office Email:   
District Address: 
Note: Your information will not be shared with individuals or organizations at any time and will be used for KASA purposes only. This information also enables us to contact you in the event of an emergency.
Do you prefer that we mail your KASA materials to your home or to your office?

Home          Office       

What method do you prefer to receive your materials?

Electronic (email)    Paper

If renewing, were you a member last year? 

Yes              No

How did you hear about KASA? 

     Please specify (if Other):

KASA Membership Categories & Annual Dues
Rate Schedule (Choose One):

Active Member -- Annual Salary x .003: (See worksheet below for dues calculation.)  School leader assigned administrative/supervisory duties at the local school or district level; a vocational school administrator; an employee of a university or college who trains teachers and administrators; an employee of the Kentucky Department of Education; or an employee of other state education interest groups, commissions, and councils. (Enter your annual salary in the Active Members Dues Worksheet)

Associate Member -- $60: (Designed for teachers, librarians, college/university professors and classified employees of a school district or other education group.) * Ineligible to serve on the board or committees, vote or receive legal funds.

Student Member -- $35:  (Designed for educators pursuing administrative certification, but who do not currently hold an administrative position) * Ineligible to serve on the board or committees, vote or receive legal funds.

Emeritus Member** -- $35: (Available to retired school administrators not working in schools or educational agencies.) * Ineligible to receive legal funds or enroll in the liability insurance program)


Active Member Dues Worksheet: (Note: Do not use commas or periods when entering numerical amounts.)

1.  Enter your annual salary           

2.  Multiply your salary by .003                       x .003

3.  Total Annual Dues                    

KASA Affiliate Membership Categories: (Note: As a member of KASA, we encourage you to join any of our affiliate organizations.
KASA will submit your membership information and payment to the affiliate no later than the 15th of the following month. Participation is contingent upon KASA membership.) 

KY Association of Elementary School Principals (KAESP) $90
KY Association of Secondary School Principals (KASSP) $100
KY Counseling Association (KCA) $50
KY School Counselor Association (KSCA) $25
KY Directors of Pupil Personnel (KDPP) $20
KY School Public Relations Association (KYSPRA) $35
National Association of Elementary School Principals (NAESP) $235
National Association of Secondary School Principals (NASSP) $250
American Association of School Administrators (AASA)




Membership Dues:

(from worksheet above)  

Affiliate Membership Dues:

(from list above)

TOTAL DUES:        
Professional Liability Coverage*:  
$79 (Fee Disclosure: Please be advised that the $79 insurance cost represents a $44 premium, $4.86 state tax fee, and $30.14 policy plan management fee.)

(* Optional coverage, MUST BE PAID IN LUMP SUM. Cannot be paid through payroll deduction, must be paid by check OR credit card only. Available to KASA members only.)



Required Legal Notice--Please Read.  KASA dues are not deductible as a charitable contribution for Federal income tax purposes, but may be partially deductible as a business expense. KASA estimates that 10% of your dues are not deductible because of KASA's lobbying activities on behalf of its members.


Dues Payment Options

Option 1: Direct Pay Method (payment in one lump sum)

Payment Enclosed (Mail check to KASA, 87 C. Michael Davenport Blvd., Frankfort, KY 40601.)

Charge my Credit Card:
   American Express    VISA    MasterCard    Discover

Name On Card:
Account No:
Expiration Date:
CCV number:
Purchase Order. My school district has issued PO #  for items listed above.



Please mail an invoice to my school district.

I have printed this membership form, submitted to my district, and a check will be mailed in the near future.


Option 2: Automatic Payroll Authorization Deduction Method (APA) for KASA & Affiliate Membership Dues

  I hereby authorize the payroll officer of my school district to deduct my KASA and/or affiliate dues and KASA insurance (excluding professional liability insurance) in 8 equal deductions in accordance with the dues structure in the KASA Constitution. Deduct the amount for insurance (excluding professional liability insurance) as authorized by me, in accordance with the rates and coverage schedule included in the insurance company brochure(s). This authorization is to remain in full force and effect unless revoked by me in writing.  Note: If electing this option, please mail paper copy to KASA, 87 C. Michael Davenport Blvd., Frankfort, KY 40601.

Choose Your District ( Note: If your district is not listed, it is not participating in the APA program at this time. )

Please Charge my Credit Card $79 for my Liability Insurance


American Express    VISA    MasterCard     Discover
Name On Card:
Account No:
Expiration Date:
CCV number:

Image Verification

(type the answer to the math problem)
MUST complete in order to submit application


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Wayne Young, Executive Director, General Counsel
Rhonda Caldwell, Deputy Director
Mary Brown, Member Relations Coordinator
Erin Howe, Membership Development Coordinator

87 C. Michael Davenport Blvd.
Frankfort, KY 40601
(800) 928-KASA or
(502) 875-3411
Fax (502) 875-4634