Member Type*

    Former name (returning member whose name has changed)

    Why do you want to join? (check all that apply)

    Full Legal Name*

    Preferred mailing address*

    City*

    State*

    Zip Code*

    Phone

    Email

    Background Information

    Spouse/Partner name

    Number of children at home ages:

    0-5
    6-12
    12-15
    15-18
    19-21

    Birthday

    Gender* [radio* radio-gender "Male" "Female"]

    Date Joining Club*

    Languages Spoken

    Corporate boards or community groups you serve with or on

    Philanthropic interests or charities you donate to

    Hobbies you enjoy

    Primary employment (check one, most recent employment if unemployed or retired)

    Agriculture/Forestry/FishingBanking/Finance/InsuranceCommunications/Media/MarketingConstruction/ExtractionEducation/TrainingGovernment/Public AdministrationManufacturingLegalHospitality/Food servicesHealthcareNon-ProfitMaintenanceReal Estate/Property ManagementReligionScienceTransportation/WarehousingWholesale/RetailIT/TechFuneral/Death services

    Other

    Name of current employer (most recent employer if unemployed or retired)

    Job classification (check one)
    ElectedSalesFreelance/Contract workProfessionalRetiredTechnicalPartner/OwnerManagementSupport/Administrative

    Highest education attained (check one)
    Primary/Grade SchoolSecondary/High SchoolTech/Business SchoolVocational/Trade schoolAssoc. Degree (2 yrs.)College/University (4 yrs.)Masters DegreeGraduate/Professional Degree

    Skill Sets/Training (check all that apply)
    Professional graphic designVideography/FilmPublic RelationsPhotographySocial mediaProfessional writing/editingStrategic planningCPA/AccountingFundraisingEvent planningYouth mentoringPolitical experienceGrant writingLegal degreeRecruitment

    By submitting this completed application for membership, I agree to conform to the bylaws of this club and comply with the obligations of membership as explained to me by my sponsor. In the United States, US$8 of a member’s annual dues and fees is applied to a Kiwanis magazine subscription. Additional membership dues and fees will be charged