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Exp Date 3 Digit Code Cardholder Signature NOTE ONLY ONE VOTE PER PAID MEMBERSHIP IN KYQHA KyQHA PO Box 23917 Lexington KY 40523-3917 - 888-367-5742 FAX 888-641-3944 - www. Youth Association Membership Dues 10 per Youth per year City County must also have KyQHA membership State Zip Home Phone Cell Phone E-mail Youth Membership Youth who have not reached 19th birthday as of Jan. 1 2011 are eligible - KyQHA Membership Required Youth Name Date of Birth required Parent/Guardian Interest...
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