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New Member Application

New Member Application

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Published by Ed Ball

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Published by: Ed Ball on Nov 08, 2012
Copyright:Attribution Non-commercial

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12/04/2012

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NewMemberInformation Form
Full Name____________________________________Nickname_________________ Gender______Home Address________________________________________________________________________________________________________Home Phone__________________________________Spouse/Partner Name______________________Company Name_________________________________________Title________________________________________Business Address______________________________________________________________________________________________________Business Phone_______________________________Fax Number______________________E-Mail Address________________________Send Kiwanis mail to: HomeWork If you are a former Kiwanian:Club Name________________________________________Date Left (mo/day/yr)__________Length of Membership___________If you are a life member, life member #_____________________Date of Birth:_________________Committee PreferenceClub AdministrationCommunity ServiceI accept this application for membership and agree to conform to the bylaws of this club andcomply with the obligations of membership as explained to me by my sponsor.Date: _________Applicant Signature: ___________________________________________
Receipt
Date _______________Received of __________________________________________________________________ $ _________________ Cash or Check For_____________________________________________________________________________Received by _______________________________
PRIMARYEMPLOYMENTCodes
1 Banking/Finance3 Comm/Media5 Construction7 Education9 Government11 Legal13 Manufact.(Heavy)15 Manufact.(Light)17 Medical19 Nonprofit21 Real Estate23 Religion25 Retail27 Transportation29 Wholesale94 Other
Codes
N. ElectedO. ManagementP. Partner/OwnerQ. ProfessionalR. SalesS. SupervisionT. TechnicalV. RetiredX. Other
Codes
A. Grade SchoolB. High SchoolC. Tech. Business SchoolD. Assoc. Degree (2 yrs.)E. Baccalaureate Degree(4 yrs.)F. Master’s DegreeG. Grad. Prof. Degree
CHECKONEBLOCKPERCATEGORY
JOB CLASSIFICATIONEDUCATIONATTAINED
City State/ProvinceZip/Postal Code
(mo/day/yr)
(mo/day/yr)
City State/ProvinceZip/Postal Code
Note: For membership statistics only. Kiwanis International does not provide its membership information to third parties.
(mo/day/yr)
Kiwanis
International

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