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Membership Application

Applicant Information

First Name

Last Name

Nickname

Home Phone

Cell Phone

Home Address

Address Line 1

Address Line 2

City

State

Zip Code

Date of birth

Spouse/Partner Name

Wedding anniversary

Employer

Title/Position

Work Address

Address Line 1

Address Line 2

City

State

Zip Code

Work Telephone

Kiwanis Mail Preference

Where would you like your Kiwanis mail sent?

Home

Business

Other

Provide mailing address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Prior Kiwanis Membership

Are you a former Kiwanian?

Yes

Name and Club Location

How long were you a member?

Background & Interests

Membership in business and/or professional organizations

Hobbies

Committee Preference

Committees are a great way to work closely with and get to know some of our members. You can find out more about our committees under the About Us page. If you would like to be assigned to a committee (optional), which would you prefer to work with?

Club Administration

Membership Growth and Orientation

Marketing and Public Relations

Financial Review

Fundraising and Grants

Park

Wilderness Trail Festival

Scholarships

Reflection Questions

In your opinion, what are the most important needs in our community today?

If you are a former member of Kiwanis or another civic club, list activities/projects you participated in that you’d like our club to consider.

Dues Acknowledgement + Signature

Dues

I understand that two months’ dues ($72) must accompany this application, and that new members are formally inducted after dues are paid up to or past the second month.

Signature

Signature date

Internal Use Only Section

Date approved by board

Date inducted into club