Account Registration - Kentucky Municipal Clerks Association

Please complete the form below. Your registration will be reviewed and a KMCA representative will contact you regarding the status of your registration.

If you are not already a member of the KMCA: After you submit the form below please mail this completed form along with a $45 check to:

Kathy Walker
Nicholasville
(859) 885-9467 (P)
(859) 885-1766 (F)
kathy.walker@nicholasville.org

All fields marked with a red asterisk are required. - (Note: - Registration may take several seconds. Once you click the Register button please wait until the system responds.)

User Name:

Enter a username. It must be at least five characters long alphanumeric value

Password:

Enter your password

Confirm Password:

Re-Enter the password to confirm you typed it correctly

First Name:

Enter a first name

Last Name:

Enter a Last Name

Email Address:

Enter a valid Email address

Municipality

Unit:

Enter a unit number for an apartment or condominium

Street:

Enter the street part of the address (eg. 123 Main Street)

City:

Enter the city part of the address

Region:

Enter the region (state, province or county) part of the address

Postal Code:

Enter the Postal/Zip Code part of the address

Telephone:

Enter a telephone number

Fax:

Enter a fax number

City Website:

Enter a web site URL.

Position

I am a new KMCA member

I am a new member to the KMCA organization.

Security Code:

Enter the security code

Enter the code shown above in the box below