Account Registration

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.)

Enter a username. It must be at least five characters long alphanumeric value
Enter your password
Re-Enter the password to confirm you typed it correctly
Enter a first name
Enter a Last Name
Enter a valid Email address
Enter a unit number for an apartment or condominium
Enter the street part of the address (eg. 123 Main Street)
Enter the city part of the address
Enter the region (state, province or county) part of the address
Enter the Postal/Zip Code part of the address
Enter a telephone number
Enter a fax number
Enter a web site URL.
I am a new member to the KMCA organization.
Enter the security code
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Enter the code shown above in the box below