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Member Application

Print and fill out this form. Return it with payment to:

KLICA

850 U.S. Hwy 77

Marysville, KS  66508

Membership Application Download

Contractor Family Member Scholarship Application

Contractor Family Members Scholarship Application. 

SCHOLARSHIP APPLICATIONS DUE ANNUALLY BY MARCH 15.

Scholarship Application Download

Contractor Member AD&D Form

Print this form if you need additional AD&D coverage for your employees.

AD&D Form Download

AD&D Insurance Policy Certificate

AD&D Insurance Coverage Certificate of Benefits/Exclusions/Provisions/Etc.

Download Certificate

Contractor Member Payment

$335.00

Pay with PayPal or a debit/credit card

Pay your Contractor Membership Dues with a credit card or Paypal account. Service Fee of 3% applies and has been added to Dues amount. When the screen appears select "Pay with Credit or Debit Card" at the bottom of the screen.