WebLink-Wide-Template-1KAM2018-11-30T11:27:49-05:00 Application To view this form, please enable JavaScript in your browser. Company Information Company Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information Address 1 Required Please enter a valid number Please enter a valid date Please enter valid credit card information Address 2 Required Please enter a valid number Please enter a valid date Please enter valid credit card information City Required Please enter a valid number Please enter a valid date Please enter valid credit card information State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Required Please enter a valid number Please enter a valid date Please enter valid credit card information Phone Required Please enter a valid number Please enter a valid date Please enter valid credit card information Fax Required Please enter a valid number Please enter a valid date Please enter valid credit card information Website Required Please enter a valid number Please enter a valid date Please enter valid credit card information Email Required Please enter a valid number Please enter a valid date Please enter valid credit card information Must be a valid email address Business Description Required Please enter a valid number Please enter a valid date Please enter valid credit card information NAICS Code Required Please enter a valid number Please enter a valid date Please enter valid credit card information Union Yes No Primary Membership Contact Copy from Company Information First Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information Last Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information Address 1 Required Please enter a valid number Please enter a valid date Please enter valid credit card information Address 2 Required Please enter a valid number Please enter a valid date Please enter valid credit card information City Required Please enter a valid number Please enter a valid date Please enter valid credit card information State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Required Please enter a valid number Please enter a valid date Please enter valid credit card information Title Required Please enter a valid number Please enter a valid date Please enter valid credit card information Phone Required Please enter a valid number Please enter a valid date Please enter valid credit card information Email Required Please enter a valid number Please enter a valid date Please enter valid credit card information Must be a valid email address Additional Contacts Top Local Executive First Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information Last Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information Title Required Please enter a valid number Please enter a valid date Please enter valid credit card information Email Address Required Please enter a valid number Please enter a valid date Please enter valid credit card information Human Resources Contact First Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information Last Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information Title Required Please enter a valid number Please enter a valid date Please enter valid credit card information Email Address Required Please enter a valid number Please enter a valid date Please enter valid credit card information Gov. Relations Contact First Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information Last Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information Title Required Please enter a valid number Please enter a valid date Please enter valid credit card information Email Address Required Please enter a valid number Please enter a valid date Please enter valid credit card information Env./Health/Safety Contact First Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information Last Name Required Please enter a valid number Please enter a valid date Please enter valid credit card information Title Required Please enter a valid number Please enter a valid date Please enter valid credit card information Email Address Required Please enter a valid number Please enter a valid date Please enter valid credit card information Billing Address (if different) Address 1 Required Please enter a valid number Please enter a valid date Please enter valid credit card information Address 2 Required Please enter a valid number Please enter a valid date Please enter valid credit card information City Required Please enter a valid number Please enter a valid date Please enter valid credit card information State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Required Please enter a valid number Please enter a valid date Please enter valid credit card information Mailing Address (if different) Address 1 Required Please enter a valid number Please enter a valid date Please enter valid credit card information Address 2 Required Please enter a valid number Please enter a valid date Please enter valid credit card information City Required Please enter a valid number Please enter a valid date Please enter valid credit card information State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Required Please enter a valid number Please enter a valid date Please enter valid credit card information Membership Investment Dues calculations: $495 company fee plus $5 per full-time Kentucky Employee Membership Type Select one... KAM Membership CIC Membership Number of Full Time Employees Total The contents of this box are for testing purposes. This box will be removed when the form goes live. Full-Time Employees Required Please enter a valid number Please enter a valid date Please enter valid credit card information Part-Time Employees Required Please enter a valid number Please enter a valid date Please enter valid credit card information Hotel/Motel Rooms Required Please enter a valid number Please enter a valid date Please enter valid credit card information Restaurant Seats Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Associates Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Associates Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Locations Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Locations Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Assets Required Please enter a valid number Please enter a valid date Please enter valid credit card information Assets Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Categories Required Please enter a valid number Please enter a valid date Please enter valid credit card information Number Of Additional Categories Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Categories Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 1 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 2 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 3 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 4 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 5 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 6 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 7 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 8 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 9 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 10 Cost Required Please enter a valid number Please enter a valid date Please enter valid credit card information Annual Dues (charged to card) Required Please enter a valid number Please enter a valid date Please enter valid credit card information Revenue Item Required Please enter a valid number Please enter a valid date Please enter valid credit card information Tax (charged to card) Required Please enter a valid number Please enter a valid date Please enter valid credit card information Fee (charged to card) Required Please enter a valid number Please enter a valid date Please enter valid credit card information Temp Value For DropDown 1 Required Please enter a valid number Please enter a valid date Please enter valid credit card information Membership Type Required Please enter a valid number Please enter a valid date Please enter valid credit card information Additional Item 1 Additional Item 2 Additional Item 3 Additional Item 4 Additional Item 5 Additional Item 6 Additional Item 7 Additional Item 8 Additional Item 9 Additional Item 10 Primary Directory Category None Accounting Association Attorney Chamber of Commerce Construction Consulting Distiller Distributor Economic/Industrial Development Educational Institution Educational Provider Employment Agency Energy/Utility Financial Advisor Financial Institution Insurance Provider Manufacturer Other Printing Supplier Additional Directory Categories Select additional directory categories below by holding the "CTRL" key Secondary categories may be subject to additional fees none Number of Part Time Employees Number of Rooms Number of Seats Number of Associates Number of Locations Millions in Assets Annual Membership Investment Additional Items Additional Categories Cost One-Time Application Fee Tax Kentucky Association of Manufacturers (KAM) is a tax-exempt 501(c)(6) association. For tax purposes, 100% of your dues should be treated as an ordinary business expense and not as a charitable contribution. KAM pays a proxy tax on lobbying expenses. You may deduct 100% of dues as a business expense and need not prorate due to lobbying expenses. Please consult your tax advisor if you have questions. Payment Type Credit Card Check NOTE: If selecting to pay by Check, please do not fill out the Credit Card Information section at the bottom of the form. Thanks. Credit Card Information Copy from Organization Information Credit Card Type MastercardVisaDiscoverAmex Credit Card Number Required Please enter a valid number Please enter a valid date Please enter valid credit card information Name on Card Required Security Code Required Valid Through 01 02 03 04 05 06 07 08 09 10 11 12 2024 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 Address Required City Required State AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY AB BC MB NB NL NS NT NU ON PE QC SK YT AG BN BS CH CL CM CP DF DU GR GT JA MC MR MX NA OA PU QE QR SI SL SO TB TL TM VE YU ZA Outside US Outside Canada Outside Mexico Zip Required Phone Required Credit Card Email Address Please click submit only one time. The transaction may take several seconds.