Kiwanis Club On-Line Application

Please complete the following form if your would like to receive membership information about our Kiwanis Club and Kiwanis International. At the end of the form, please indicate how you would like the information sent (Electronic Mail,U.S. Mail, or a call from a member).

First Name: Middle Name: Last Name:
Address1:
Address2:
City State Zip/Postal
Country:
Daytime Phone:
Evening Phone:
Fax Phone:
Email Address:

How would you like us to provide you information?
Surface Mail Telephone Email

Are you interested in joining a Kiwanis Club?
YES NO

Are you a member of another community service club?
YES NO
If YES, indicate club name?

Enter Comments Below:

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