Member Directory Form

Please select one of the following options: *

No cost - Basic Directory Listing included with your annual membership.
$50 - Directory Listing with embedded links to your website and social media (expires on your KPBA anniversary)***Purchase an ad and this fee waived!***
$150 - Don't have a website? We'll create a page on ours for you. You provide pictures, coupons, job postings, etc.; we'll do the rest!

Company Name *

Representative Name *

First

Last

Street Address

Address Line 1

Address Line 2

City

State

Zip Code

Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Which address do you want listed in our Directory? *

Physical Address
Mailing Address
Do not list an address.

Main Phone Number To Be Listed in Directory *

Fax Number

Mobile Number - Enter only if you want this listed in Directory.

Is it okay to text this number?

Email - To Be Listed in Directory *

Email

Confirm Email

Business License # *

Professional License #

Residential Endorsement #

Website / URL

Facebook

Instagram

Twitter

Type of Business *

Include all services your company performs, use a comma between each.

Brief Company Bio - Please include key words and categories to make your company easier to find using our built-in search engine online. *

Include Year started, date of Membership, etc.

Are you interested in volunteering to be on a committee? Check all that apply. We will contact you with additional information.

Are you interested in being a guest speaker at a Members Meeting? *

Yes
No

Would you like to submit an ad in our Directory for print & online? ***NOTE: Purchase of an ad waives the "$50" fee for embedded links in your online directory listing.*** *

Please select one option if interested. All ads will be linked to your choice of website or social media in the online Directory. The online Directory will be updated monthly to reflect current members and any changes submitted by members. Ads will be run online for one year from original posting date and in all printed copies.

Comment or Message *

Please sign your name, attesting everything above is true and accurate. *

Upload your logo in a .jpg or .png format

Already have an ad? Upload it here.

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