KITSAP ADOPTION GROUP
MEMBERSHIP APPLICATION
Send $20 to
KAG c/o Cindy Berry P O Box 3305
Silverdale WA 98383-3305
Name(s) __________________________________________________________________________________________
Address __________________________________________________________________________________________
City _____________________________________________ State _________________ Zip Code________________
Phone ___________________________ e-mail address __________________________________________________
Child _________________________________________ Age ________ Country _______________________________
Agency ____________________________________________________ Date of Placement ______________________
Child _________________________________________ Age ________ Country _______________________________
Agency __________________________________________ __________Date of Placement ______________________
Child _________________________________________ Age ________ Country _______________________________
Agency _____________________________________________________Date of Placement ______________________
