Become a Member — Kiwassee Kiwanis

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Membership Application

Join the Kiwassee Kiwanis Club and make a difference today!

About You

First Name *

Last Name *

Spouse's First Name

Spouse's Last Name

Gender

Date of Birth *

Street Address *

Address Line 2

City *

ZIP Code *

How Can We Reach You

Personal Phone *

Business Phone

Email Address *

Preferred Method of Contact

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Are You a Former Kiwanian?

Club Name

Date Left (mm/dd/yyyy)

Length of Membership

Lifetime Member # (if applicable)

Kiwanian Preferences

Note: Category selections are for membership statistic only. Kiwanis International does not provide its membership information to third parties.

Committee Preference

Club Administration

Community Service

Job Classification

Primary Employment

Education Attained

Application Submission

I accept this application membership and agree to conform to the bylaws of this club and comply with the obligations of membership as explained to me by my sponsor.

Submission Confirmation *

Submit Application

Date *

Verification Code *