KBA - Member Application

Type of Member	{typeOfMember}
Month of Application	{monthSubmitted}
1 year membership or 2?{1Year}	{1Year}
MEMBERSHIP COST	{membershipCost}
	{input63}
Changes Needed:	{typeA64}
Business/Organization Name	{businessorganizationName}
Year Established	{businessorganizationName69}
Business Email Address	{businessEmail}
Business Phone Number	{businessPhoneNumber}
Website / Social URL	{businessWebsiteURL}
Business Logo	{input53}
Physical address same as Mailing	{isYour}
Physical Address	{businessPhysicalAddress}
Mailing Address	{businessMailingAddress}
Business Categories	{businessCategory}
DO YOU HAVE A SECOND BUSINESS THAT YOU WOULD ALSO LIKE TO REGISTER OR RENEW? Second businesses registered by the same owner receive half off membership price when registered at the same time as the first business. (If you already have registered a business and would like to add a second at a later time, please contact the KBA at info@killinglyba.org.)	{doYou}
Second Business: Type of Member	{typeOf}
Second Business: Month of Application Submission	{secondBusiness94}
Second Business: 1 year membership or 2?	{1Year78}
SECOND BUSINESS MEMBERSHIP COST	{secondBusiness95}
Second Business: Please review your current listing at www.killinglyba.org/directory	{secondBusiness90}
Second Business: Please detail the changes needed.	{secondBusiness91}
Second Business/Organization Name	{secondBusinessorganization}
Second Business: Year Established	{secondBusiness}
Second Business: Email Address	{secondBusiness81}
Second Business: Phone Number	{secondBusiness82}
Second Business: Website / Social URL	{secondBusiness84}
Second Business: Upload Business Logo	{secondBusiness85}
Second Business: Is your physical address the same as your mailing address?	{secondBusiness86}
Second Business: Physical Address	{secondBusiness87}
Second Business: Mailing Address (if different)	{secondBusiness88}
Second Business: Please select up to 2 categories for your business;	{secondBusiness89}
Committee	{committee}
KBA-Primary Contact	{primaryContact}
Phone Number	{primaryContactPhone}
Email Address	{primaryContactEmail}
TOTAL CHARGES:	{totalCharges}
Payment Method	{paymentMethod}
Payment Methods	{PaymentMethods}

Type of Member*

New MemberExisting Member - Renewal
Month of Application Submission*
1 year membership or 2?*

1 year membership ($120)2 year membership ($220 - save $10 per year!)
MEMBERSHIP COST
**pro-rated membership**
Annual Membership runs from January 1 to December 31 – and is pro-rated $10/month beginning in July.
Please review your current listing at www.killinglyba.org/directory*

YES - our directory listing is accurateNO - updates are needed to our listing
Please detail the changes needed.
Business/Organization Name*
Year Established*
Business Email Address*
example@example.com
Business Phone Number*
Website / Social URL*
Upload Business Logo

jpg, jpeg, png, gif
Cancelof
Is your physical address the same as your mailing address?*

YESNO
Business Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Mailing Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please select up to 2 categories for your business;*

AntiquesArtsAttorneyAutomotiveBank - Financial ServicesBusiness ServicesCivic/Non-Profit OrganizationsConstruction - LandscapingEducationEntertainmentGovernmentHealth & WellnessInsuranceLodgingManufacturingMediaMuseumPet ServicesPersonal ServicesReal Estate - DevelopmentReligiousRestaurantRetailSportsTrade ServicesTransportationTravel
DO YOU HAVE A SECOND BUSINESS THAT YOU WOULD ALSO LIKE TO REGISTER OR RENEW? Second businesses registered by the same owner receive half off membership price when registered at the same time as the first business. (If you already have registered a business and would like to add a second at a later time, please contact the KBA at info@killinglyba.org.)

Yes
Second Business: Type of Member*

New MemberExisting Member - Renewal
Second Business: Month of Application Submission*
Second Business: 1 year membership or 2?*

1 year membership ($60)2 year membership ($110 - save $5 per year!)
SECOND BUSINESS MEMBERSHIP COST
**pre-rated membership**
Membership will be pre-rated for 2024-membership period. Annual Membership runs from January 1 to December 31.
Second Business: Please review your current listing at www.killinglyba.org/directory*

YES - our directory listing is accurateNO - updates are needed to our listing
Second Business: Please detail the changes needed.
Second Business/Organization Name*
Second Business: Year Established*
Second Business: Email Address*
example@example.com
Second Business: Phone Number*
Second Business: Website / Social URL*
Second Business: Upload Business Logo

jpg, jpeg, png, gif
Cancelof
Second Business: Is your physical address the same as your mailing address?*

YESNO
Second Business: Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Second Business: Mailing Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Second Business: Please select up to 2 categories for your business;*

AntiquesArtsAttorneyAutomotiveBank - Financial ServicesBusiness ServicesCivic/Non-Profit OrganizationsConstruction - LandscapingEducationEntertainmentGovernmentHealth & WellnessInsuranceLodgingManufacturingMediaMuseumPet ServicesPersonal ServicesReal Estate - DevelopmentReligiousRestaurantRetailSportsTrade ServicesTransportationTravel
Please select a committee to participate in;

MembershipEvents & FundraisingBeautificationMarketing & Advertising
KBA-Primary Contact*

First NameLast Name
Phone Number*
Email Address*
example@example.com

TOTAL CHARGES:
Payment Method*

OnlineCheck
Membership Total Cost: {totalCharges}

Checks or Money Orders should be made payable to Killingly Business Association
and mailed to:

C/O Membership Committee
Killingly Business Association, 172 Main Street, Danielson, CT 06239
My Products

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Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

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