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Children are our focus

New Member Application Form

Thank you for your interest in our Kiwanis Club. Please fill out the form below. A few fields are required, the rest are to get better acquainted. You may save the form and finish later.

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 country where the club is located.

Member type *New Kiwanis memberFormer Kiwanis memberCurrent Kiwanis memberTransferring Kiwanis memberHonorary Kiwanis memberCorporate Kiwanis memberFormer Service Leadership Program member

Former name (returning member whose name has changed)

Why do you want to join? (check all that apply)To help kidsCommunity involvementBusiness networkingTo make friendsLeadership skillsOther

Sponsor name(s)

Contact information

PrefixMr.Mrs.Ms.Dr.Rev.NoneOther

Other

First Name *

Middle Name

Last Name *

Preferred

Street Address *

City *

Province *

Postal Code *

Phone

HomeWorkCell

Email Address *

homework

Background information

Spouse/partner name

0-5Number of children at home (per age)

6-12

12-15

15-18

Birthdate

Day

Month

Year

Corporate boards or community groups you serve with or on

Philanthropic interests or charities you donate to

Hobbies you enjoy

Primary employmentAgriculture/Forestry/FishingBanking/Finance/InsuranceCommunications/Media/MarketingConstruction/ExtractionEducation/TrainingGovernment/Public AdministrationManufacturingLegalHospitality/Food servicesHealthcareNon-ProfitMaintenanceReal Estate/Property ManagementReligionScienceTransportation/WarehousingWholesale/RetailOther(check one, most recent employment if unemployed or retired)

Other employment

Name of current employer (most recent employer if unemployed or retired) _

Job classification (check one)ElectedSalesFreelance/Contract workProfessionalRetiredTechnicalPartner/OwnerManagementSupport/AdministrativeOther

Other

Highest education attained (check one)Primary/Grade SchoolSecundary/High SchoolTech/Business SchoolVocational/Trade SchoolAssoc Degree (2 yrs)College/University (4 yrs)Masters DegreeGraduate/Professional Degree

Degree(s) earned

Skill sets/Training (chack all that apply)Professional graphic designVideography/FilmPublic RelationsPhotographySocial mediaProfessional writing/editingStrategic planningCPA/AccountingFundraisingEvent planningYouth mentoringPolitical experienceGrant writingLegal degreeRecruitment

Consent *

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 Kiwanis magazine subscription. Additional membership dues and fees will be charged.

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