Join the Club
Fill out this form and start making an impact on children’s lives!
Full name ________________________________ Nickname __________ Gender _______
Date of birth (mo/day/yr) _______________ Spouse/partner name _____________________
Home address __________________________ City __________ State _______ Zip _________
Home phone _____________________ Email ________________________________________
Company Name _______________________________ Title ____________________________
Business address ________________________ City _________ State ________ Zip _________
Business phone ___________________ Email ________________________________________
Send Kiwanis mail to:
Home
Are you a former Kiwanian?
Business
Yes
No If yes, club Name ______________________
Date left (mo/yr) ________________ Length of membership (months/years) ______________
If you are a life member, life member # _____________________________________________
Committee Preference
50/50 Drawing
Community Days
Fruit & Pie Sale
Inter-Club Meeting
Miracle League
Programs
Read America
Special Needs Party
Website/Portal
By-laws & regulations
Early Childhood Endeavor
Halloween Parade
Key/Builders Club
Nominating
Publicity
A Road Clean-Up
A
n Spiritual Aims
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Welfare/Visitation
Communication
Easter Egg Hunt
House
Membership
Pancake Festival
Putt-U Mini Golf
Scholarships
Tree Lighting
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I accept this application for membership
and agree to conform to the bylaws of this club and
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comply with the obligations of membership as explained to me by my sponsor.
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By providing my email address, I recognize that I am opting in to receive regular
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communication from Kiwanis International.
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Applicant signature _____________________________________________
Date __________
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