Kiwanis Club Membership Form

Gender*
Complete Address with Zip/Postal Code.
Complete Address with Zip/Postal Code.
Send Kiwanis mail to:*
Date of Birth:*
Committe Preference*
Date
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Primary Employment*
Job Classification*
Education Attained*

New Member Sponsor:

Date
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Recommended by Membership Committe:

Date:
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Elected To Membership by Board of Directors:

Date
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Member Accomplishments: