Kentucky Education Associates
 401 Capital Avenue   |   Frankfort, KY 40601   |   800.231.4532   |   502.875.2889
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KEA Local Officer Reporting Form

Local Association:
Term Begins:
Term Ends:



President:
Type:
New
Ongoing
 
Address:
City:
State:
Zip:
 
Home Phone:
Cell Phone:
Email:
 
School Address:
City:
State:
Zip:
 
Phone:
Fax:



Vice President/President Elect:
Type:
New
Ongoing
 
Address:
City:
State:
Zip:
 
Home Phone:
Cell Phone:
Email:
 
School Address:
City:
State:
Zip:
 
Phone:
Fax:



Secretary:
Type:
New
Ongoing
 
Address:
City:
State:
Zip:
 
Home Phone:
Cell Phone:
Email:
 
School Address:
City:
State:
Zip:
 
Phone:
Fax:



Treasurer:
Type:
New
Ongoing
 
Address:
City:
State:
Zip:
 
Home Phone:
Cell Phone:
Email:
 
School Address:
City:
State:
Zip:
 
Phone:
Fax:



Signature:
Date: