Kiwanis Club Membership Information Request Form

Please complete the following form if you would like to receive membership information about our Kiwanis Club and Kiwanis International. You may print the completed form and mail it to the Webmaster (at the address above); or you may copy the completed form and e-mail it to the Webmaster (see e-mail address above).

At the end of the form, please indicate how you would like the information sent (Electronic Mail, U.S. Mail, or a call from a member).

First Name:
	   
Middle Name:
	
Last Name:
	
Address1:
	
Address2:
	
City:
	
State:
	
Zip/Postal:
	
Country:
	
Daytime Phone: 
	
Evening Phone: 
	
Fax Phone:     
	
Email Address: 
	

How would you like us to provide you information?
Surface Mail    
	Telephone       
	Email           
	

Are you interested in joining a Kiwanis Club?
	YES
	NO 

Are you a member of another community service club? 
	 YES 
	 NO 
If YES, indicate club name?  
	

Enter Comments Below:
	

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