Become a Kiwanis Member

Name*

First Last

Nickname

First

Email*

Enter Email Confirm Email

Cell Phone*

Home Phone

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Address*

Street Address Address Line 2 City State ZIP Code

Section Break

Gender*

Birthdate*

Corporate Membership?*

Company Name

Title

Business Email

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Business Phone

Business Address

Street Address Address Line 2 City State ZIP Code

Send Kiwanis Email to

Send Kiwanis Mail to

Application Date*

Membership Fees

Total

$0.00

Consent*

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

Credit Card

Card Details

Cardholder Name

Email

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