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KBA CHANGE OF CONTACT INFORMATION FORM
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Please
use this form to let the KBA know if you have any contact changes, including changes to your name, address, phone
or fax numbers,
e-mail
address, etc., or if you wish to change your billing and
mailing information.
Be aware the KBA is separate from Attorney Registration with the Clerk of the Kansas Supreme Court; separate attorney databases are maintained. When making contact information changes you should also notify Attorney Registration at (785) 296-8409 and the Kansas CLE Commission at (785) 357-6510.
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A.
Old Contact Information
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Note:
Items in boldface are required fields.
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KBA
membership number:
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Full name (first,
middle initial, last):
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Old Firm/Company/Agency
name:
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Old Street address:
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Old PO
Box number:
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Old City, State,
and Zip+4:
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***
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Old
County:
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Old e-mail address:
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Old telephone number:
****Old fax number:
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B.
New Contact Information
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Date
that the changes you indicate below will take effect:
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Name
changed to:
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New Firm/Company/Agency
name:
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New Street address:
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New PO
Box number:
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New City, State, and
Zip+4:
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***
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New
County:
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New e-mail address:
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New telephone number:
****New fax number:
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C.
Alternate/Home Contact Information
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Alternate/Home Street
address:
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Alternate/Home
PO Box
number:
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Alternate/Home City,
State, and Zip+4:
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***
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Alternate/Home
County:
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Alternate/Home e-mail
address:
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Alternate/Home telephone
number:
****Alternate/Home fax number:
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D.
Preferred Mailing and Billing Information
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**
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E.
Other Information
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Please
use the space below for additional information or comments:
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