Apply to become a member of Kiwanis of West Lincoln

Full Name*

First Middle Last

Nickname

Date of Birth*

Spouse / Partner Name

First Middle Last

Primary Address*

Street Address Address Line 2 City Province Postal Code

Prefered Phone*

Cell
Home
Work

Email

By providing my email address, I recognize that I am opting to receive regular communications from Kiwanis International.

Joining as*

Member
Corporate Member
Other

Company Name

Member Sponsor Name (If Applicable)

First Last

Are you a former Kiwanian?*

Yes
No

Are you a former K-Kids, Buiilders Club, Key Club or CKI member?*

Yes
No

If yes, club name(s)

Application Date*

I accept this application for membership and agree to conform to the bylaws of this club and comply with the obligations of membership as explained to me by my sponsor.*

Yes

Name

This field is for validation purposes and should be left unchanged.

Kids Need Kiwanis

Apply to become a member of Kiwanis of West Lincoln