Please print and fill out the form below and return, with your payment, to KAGE, PO Box 9610, Bowling Green, KY 42102-9610. If you have any questions please contact the KAGE office at 270.745.4301 or kage@wku.edu.
Name:____________________________________________
Address:____________________________________
City:____________________________State:______Zip Code:__________
School District:________________________
County of Residence:___________________
KAGE Chapter: ________________________
Preferred phone:__________________________ This is home___ work___.
Email address:_________________________________
Would you like to be placed on the KAGE LISTSERV? __ yes __ no
CLASSIFICATION(S):
_____ Parent _____ Teacher _____ Resource Teacher _____ Gifted Coordinator _____ Counselor _____ Administrator _____ Resource Teacher _____ Other______________
TYPE OF MEMBERSHIP: __New __ Renewal
Annual membership is $30 per household. The NAGC Parent Associate membership (enables you to receive four issues of Parenting for High Potential and access to all resources on NAGC’s website at www.nagc.org) is an additional $15.
KAGE FOUNDATION
KAGE members are encouraged to include a contribution to the KAGE Foundation when initiating or renewing their KAGE memberships. The KAGE Foundation provides scholarship assistance for gifted students attending summer programs offered by Kentucky universities. Foundation contributions are tax-deductible. If you are including a contribution please fill in the amount here: $________ Check Number________
_____ $30 KAGE membership ____$15 NAGC parent associate _____ KAGE Foundation donation ______TOTAL ENCLOSED
