Dawn Busters
Member Forms
New Member Application
Name
*
First
Last
Nickname
First
Email
*
Enter Email
Confirm Email
Cell Phone
*
Home Phone
Optional
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Gender
*
Male
Female
Birthdate
*
Month
Day
Year
Spouse/Partner Name
First
Last
Spouse/Partner Birthdate
Month
Day
Year
Wedding Anniversary Date
Month
Day
Year
Corporate Membership?
*
Yes
No
Company Name
Title
Business Email
Enter Email
Confirm Email
Business Phone
Business Address
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Send Kiwanis Email to
Home Email Address
Business Email Address
Send Kiwanis Mail to
Home Address
Business Address
Are you a former Kiwanian?
*
Yes
No
Sponsor's Name
Who is the person that brought you into the Club?
First
Last
Cosponsor's Name
If you had more than one person that brought you into the Club, who was the other person?
First
Last
Application Date
*
Month
Day
Year
Membership Type
*
Regular Membership
Educator Membership
Spouse Membership
Under 25 Sponsored Youth Membership
Membership Fee & Dues
*
Membership Fee ($100) + First Quarter Dues ($40) + Processing fee ($4.49)
Membership Fee ($100) + First Year Dues ($160) + Processing fee ($8.07)
Choose to pay Dues for First Quarter or First Year
Corporate Membership Fee & Dues
*
Corporate Membership Fee ($100) + First Quarter Dues ($40) + Processing fee ($4.49)
Corporate Membership Fee ($100) + First Year Dues ($160) + Processing fee ($8.07)
Choose to pay Dues for First Quarter or First Year
Educator Membership Fee & Dues
*
Educator Membership Fee ($50) + First Quarter Dues ($30) + Processing fee ($2.70)
Educator Membership Fee ($50) + First Year Dues ($120) + Processing fee ($5.39)
Choose to pay Dues for First Quarter or First Year
Spouse Membership Fee & Dues
*
Spouse Membership Fee ($50) + First Quarter Dues ($20) + Processing fee ($2.40)
Spouse Membership Fee ($50) + First Year Dues ($80) + Processing fee ($4.19)
Choose to pay Dues for First Quarter or First Year
Spouse Membership Fee & Dues
*
Under 25 Sponsored Youth Membership Fee ($25) + First Quarter Dues ($15) + Processing fee ($1.50)
Under 25 Sponsored Youth Membership Fee ($25) + First Year Dues ($60) + Processing fee ($2.85)
Choose to pay Dues for First Quarter or First Year
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.
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New Member Application