Kansas Collegiate Farm Bureau Membership Form

Kansas Collegiate Farm Bureau Membership Form
Name

First NameLast Name
Email
You will get a confirmation email to this address after submission
I am a
Has your personal information such as phone or addresses changed since last year?

Member Information
If you know your membership number, enter it here
KFB Membership numbers start with 150
Birthdate

MonthDayYear
Date
Gender
Mobile Phone
Format: (000) 000-0000.
Would you like to receive text messages about Kansas Farm Bureau?
Current Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Permanent Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Home County
What is your home state and home county?
Select your shirt size
Are you married?
Kansas Farm Bureau offers Family Memberships that will extend your membership benefits to your spouse, if you are married.
Enter your spouse's name

First NameLast Name

School/Chapter Information
Are you transferring from one chapter to another?
Select the chapter you were part of LAST year
Which college are you attending this year?
Year in College
Major
At this point, do you plan to graduate or transfer during or at the end of this academic year?
Graduation Date

MonthDayYear
Date
What will be your new permanent email address after you graduate?
Please enter a non-school related email address.
Degree
Tell us about your career plans after graduation
County for complimentary FB membership
What is the state and county of your complimentary FB membership
What school are you transferring to?
What do you intend to study?
Are you a chapter officer?
Enter your chapter officer title

Payment Information
Internal Codes (Optional)
Only enter something in this box if you've been instructed to by KFB staff
Total Due

USDDescription

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Member Information