Form Ps - Professional Solicitor Application printable pdf download

Form Ps - Professional Solicitor Application

Secretary of State/Corporation Division

Form

Professional Solicitor Application

I, _____________________________________, first duly sworn, and upon my oath allege and state:

(Please print name of applicant clearly)

That I hereby make application for Registration/Reregistration (circle one) as a Professional Solicitor. I am a

professional solicitor employed by a professional fund raiser, duly registered with the Secretary of State of

Kansas. The professional fund raiser for which I will be a solicitor:

__________________________________

Name of Professional Fund Raiser

Name of Applicant

__________________________________

Street Address

Street Address of Applicant

__________________________________

City, State, Zip

__________________________________

Phone (Area Code and Number)

__________________________________

Date of Application

I declare (or verify, certify or state) under penalty of perjury under the laws of the State of Kansas that the

foregoing is true and correct.

Executed on ________________________

Month/Date/Year

__________________________________

Signature of Applicant

__________________________________

Signature of Professional Fund Raiser

Note: This registration/reregistration 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 for additional one-year periods.

Mail to:

Ron Thornburgh

Secretary of State

First Floor, Memorial Hall

120 S.W. 10th Ave.

Topeka, KS 66612-1594

(785) 296-4564

Rev. 6/00 kp

Form Ps - Professional Solicitor Application