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 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 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