Kids Need Kiwanis

New Member Information

Please complete

This form is sent to a new member to get all of the data needed to add them to the roster

Name*
First Last
Nickname
First
Email*
Enter Email Confirm Email
Cell Phone*
Home Phone
Optional
Address*
Street Address Address Line 2 City State ZIP Code
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Gender*
- Male
- Female
Birthdate*
Month
Day
Year
Section Break
Spouse/Partner Name
First Last
Spouse/Partner Birthdate
Month
Day
Year
Wedding Anniversary Date
Month
Day
Year
Section Break
Corporate Membership?*
- Yes
- No
Are you joining as an individual or as a corporation and you are its representative.
Company Name
Title
Business Email
Enter Email Confirm Email
Business Phone
Business Address
Street Address Address Line 2 City State ZIP Code
Send Kiwanis Email to
- Home Email Address
- Business Email Address
Send Kiwanis Mail to
- Home Address
- Business Address
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Are you a former Kiwanian?*
- Yes
- No
Section Break
Sponsor's Name
Who is the person that brought you into the Club?
First Last
Date of Form*
Month
Day
Year
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