Key Leader – Student Registration 2025 – Pennsylvania District Kiwanis International

Contact Details

Name(Required)

First Last

Preferred Name(Required)

Gender(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

School Email(Required)

Personal Email(Required)

Cell Phone(Required)

Parent/Guardian's Name(Required)

First Last

Parent/Guardian's Cell Phone(Required)

Parent/Guardian's Email(Required)

Please enter a valid Parent/Guardian Email as a copy of this registration will be sent to this email.

Event Details

How do you plan to travel to Key Leader?(Required)

If you selected OTHER or RIDE WITH ANOTHER STUDENT, please indicate the student's name or other travel plans:

Restrictions(Required)

Check all that apply

Dietary Restriction(s)

Medical Restriction(s)

None

Dietary/Medical Restrictions

Please indicate any Dietary or Medical restrictions

High School Name(Required)

Current Grade Level(Required)

Are you currently a Key Club Member?(Required)

Yes

No

Have you attended a Key Leader Event in the past?(Required)

Yes

No

How did you hear about this event?(Required)

Key Leader Weekend

Price:

Payment Details

Total

Payment Options

If you select CHECK, please mail checks payable to “PENNSYLVANIA KIWANIS” to District Treasurer, Ben Osterhout, 1357 Willow Creek Drive, Mount Joy PA 17552

Credit Card

Kids Need Kiwanis

Key Leader – Student Registration 2025

Contact Details

Event Details

Payment Details

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