Membership Application

Name *

Name

First Name

Last Name

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address *

Phone Number *

Emergency Contact (Name and Phone Number) *

What is your prior photography and/or darkroom experience? *

Do you have a website?

http://

Membership Plan *

Please choose your type of membership to KCD. Memberships are non-refundable, non-transferable to another individual, and will not carry over to a new month if you do not work in the current month.

Type your name and date to digitally sign this document. *