Become a Kiwanis Member

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

Section Break

Gender*

Male
Female

Birthdate*

Section Break

Spouse/Partner Name

First Last

Spouse/Partner Birthdate

Wedding Anniversary Date

Section Break

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

Section Break

Are you a former Kiwanian?*

Yes
No

Section Break

Sponsor's Name

Who is the person that brought you into the Club?

First Last

Application Date*

Membership Fee & First Quarter Dues*

Membership Fee + First Quarter Dues
Educator Membership Fee + First Quarter dues
Spouse Membership Fee + First Quarter Dues
Under 25 Sponsored Youth Membership Fee + First Quarter Dues

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

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

CAPTCHA

Kids Need Kiwanis

New Member Application and Payment Form

Section Break

Section Break

Section Break

Section Break

Section Break