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Kids Need Kiwanis

New Member Application

New Member Application and Payment Form Template

Name of Kiwanis Club*
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
Gender*
- Male
- Female
Birthdate*
Month
Day
Year
Spouse/Partner Name
First Last
Wedding Anniversary Date
Month
Day
Year
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
Are you a former Kiwanian?*
- Yes
- No
Sponsor's Name
Who is the person who brought you into the Club?
First Last
Application Date*
Month
Day
Year
Membership Fee*
- Membership Fee
- Under 25 Sponsored Youth Membership Fee
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.
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Pennsylvania Kiwanis

24 hours ago

Our Pennsylvania District of Circle K International is looking for your support!
InterPACK is the college students 1st weekend together as a District for service and leadership! Can you support them?
www.amazon.com/hz/wishlist/ls/6JETCU8H5D95?ref_=wl_share ... See MoreSee Less

Our Pennsylvania District of Circle K International is looking for your support!
InterPACK is the college students 1st weekend together as a District for service and leadership! Can you support them?
https://www.amazon.com/hz/wishlist/ls/6JETCU8H5D95?ref_=wl_share

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Pennsylvania Kiwanis

1 week ago

... See MoreSee Less

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PA District Kiwanis International

125 North Enola Drive, Suite 206

Enola, PA 17025

Phone: 717.540.9300

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