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