Form Ps - Professional Solicitor Application Page 2
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28. Other states in which the fund raiser is registered:
9. Attached hereto are all contracts entered into between me and charitable organizations to act as a professional fund
raiser or form PO for each charitable organization.
10. I declare under penalty of perjury under the laws of the state of Kansas that the foregoing is true and correct.
Executed on the ________ of ______________ , _____________ .
Day
Month
Year
Signature of applicant
Date of application
Street address
City
State
Zip
Instructions
1. Please enclose the $25 filing fee made payable to the Secretary of State with the form.
Do not send cash.
2. This registration/re-registration shall be for a period of one year, or a part thereof, expiring on the
30th day of June and may be renewed upon written application, under oath, in the form prescribed
by the Secretary of State for additional one-year periods.
Notice: There is a $25 service fee for all returned checks.
Rev. 4/20/05 jls
K.S.A 17-1764
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