To help us support you, please provide the information below. We have clubs for every age and ability, but to become a member of Kiwanis you must be the legal age of adulthood in the state or county where the club is located.

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Member type* *

• New kiwanis member
• Former kiwanis member
• Current kiwanis member
• Transferring kiwanis member
• Honorary kiwanis member
• Corporate kiwanis member
• Former Service Leadership Program Member

Former name

Why do you want to join?(check all that changed)

• To help kids
• Community involvement
• Business networking
• To make friends
• Leadership skills

Sponsor(s) names

prefix

• Mr.
• Mrs.
• Ms.
• Dr.
• Rev.
• None

Full Legal Name *

First

Last

Preferred Mailing address *

city *

State/Province

Postal code

choice

• home
• work

Phone Number

Multiple Choice

• home
• work
• cell

Email *

Multiple Choice

• home
• work
• cell

Spouse/Partner name

Number of children at home ages:

• 0 - 5
• 6 - 12
• 12 - 15
• 15 - 18
• 19 - 21

Birthday mo./day/year

Gender

Date joining club* *

Languages spoken

Corporate boards or community groups you serve with or on:

Philanthropic interestsor charities you donate to:

Hobbies you enjoy

Primary employment (check one, most recent employment if unemployed or retired)

• Agriculture/Forestry/Fishing
• Banking/Finance/Insurance
• Communications/Media/Marketing
• Construction/Extraction
• Education/Training
• Government/Public Administration
• Manufacturing
• Legel
• Hospitality/Food Services
• Healthcare
• Non-Profit
• Maintenance
• Real Estate/Property Management
• Religion
• Science
• Transportation/Warehousing
• Wholesale/Retail
• It/Tech
• Funeral/Death Services
• Other

name of current employer (most recent employment if unemployed or retired)

Job classification (check one)

• Elected
• Sales
• Freelance/Contract Work
• Professional
• Retired
• Technical
• Patner/Owner
• Management
• Support/Administrative
• Other

Highest education attained (check one)

• Primary/Grade School
• Secondary/High School
• Tech/Business School
• Vocational/Trade School
• Assoc. Degree(2 yrs.)
• College/University(4 yrs.)
• Masters Degree
• Gradute/Professional Degree

Degree(s) earned

Skill sets/Training (check all that apply)

• Professional graphic design
• Videography/Film
• Public Relations
• Photography
• Social Media
• Professional writing/editing
• Strategic planning
• CPA/Accounting
• Fundraising
• Events planning
• Youth mentoring
• Political experience
• Grant writing
• Legal degree
• Recruitment

By completing this application for membership, I agree to conform to the bylaws of this club and comply with the obligations of membership as explained to me by my sponsor. In the United States, US$8 of a member's annual dues and fees is applied to a Kiwnis magazine subscription. Additional membership dues and fees will be charged.Signature *

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