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Membership Form

    Name

    Nickname

    Home Address

    City

    State

    Zip

    Home Phone

    Firm Name

    Type of Business

    Business Address

    City

    State

    Zip

    Business Phone

    Title of Your Position

    Email Address

    Where do you want Kiwanis mail sent?

    Home AddressBusiness AddressEmail Only

    Are you a former Kiwanian?

    YesNo

    Name of Club

    Length of Membership

    How long have you lived in our community?

    Who is/are your Kiwanis sponsor(s)?

    Birthday (dd/mm):

    Anniversary Date (dd/mm):

    Spouse/Partner Name:

    Primary Employment:

    Job Classification:

    Education Attained: