Kiwanis Club Information Request Form

Kiwanis Club Membership Information Request Form

Please complete the following form if your would like to receive membership information about our Kiwanis Club and Kiwanis International. 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?  

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