Membership Form

Full Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Spouse/Partner Name

First Name

Last Name

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Preferred Phone *

(###)

###

####

Committee Preference

Select all that apply.

Programs

Service & Fundraising

Membership

Financial Review

Are you a former Kiwanian? *

Yes

No

Are you a former Key Club or CKI Member?? *

Yes

No