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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 Address Business Address Email Only

Are you a former Kiwanian?
 Yes No

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:

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Become a member and make a difference in your community.