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D. Mark this box if you are using additional pages. Contact Us toll free: 1-888-275-5737 phone: 785-296-6166 fax: 785-296-6638 e-mail: kpers kpers.org web site: www.kpers.org mail: 611 S. Kansas Ave., Suite 100, Topeka, KS 66603 Part A Member Information 1. Social Security Number: - - 2. Name (First, MI, Last): 3. Telephone Number: ( ) 4. Mailing Address:.

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