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[CKI@UCR] Membership Form
Hi homies! My name is Jack Chen and I am the Treasurer of Circle K International at UCR! I'm happy that you've stumbled onto this little form of mine, and I can't wait to begin the new year with you all. :D So let's get started!

To become an official member of Circle K International at University of California, Riverside, one must fill out this form and submit payment by the payment methods listed in this form.

The membership fee is $35:
-$10 for District Fees
-$10 for 2020-2021 Club T-Shirt (Camping is our theme)
-The rest is for our Administrative Funds

This membership will cover you and your Circle K journey for one whole year! Your benefits include:
-Saying you're a member of CKI @UCR!
-Entering our Big & Little mentor program!
-Entering our Family system
-Awesome Wake up for Service T-shirt!
-Priority for rides to events (community service, fundraisers, socials!)
-Ability to attend California-Nevada-Hawaii District events (Fall Training Conference, CNH District Convention & more!)
-Ability to attend Desert Oasis Division events
-Leadership opportunities! (chairing an event, applying for board positions, plan your own workshop, plan your own service & more!)
-Becoming a part of the Kiwanis Family
-Networking, professional development, friendships!

If you have any questions regarding this form or anything about the club in general, please contact me, Jack Chen, through Facebook,, or (626) 861-8011. Thank you for your time!
Email address *
First Name *
Last Name *
Current Address *
City *
State *
Graduation Year *
Phone Number *
Can we text you at the number above? *
If you answered "No," please provide a texting number if you have one:
Birthdate *
Have you ever been a member of the Kiwanis Family? (ex: Key Club, KIWIN's) *
If yes, please specify school and city:
Payment Method *
T-Shirt Size *
Captionless Image
Will you be living on campus this quarter? *
Shipping address (please put on campus if you answered yes previously) *
221B Baker Street
Sexual Misconduct Policy *
Please note that sexual misconduct is strictly forbidden within our club and we have the right to file an investigation if such situations occur. For more information:
I consent and authorize Circle K at UC Riverside or any entity authorized by Circle K International (such as a Circle K club or district) to copyright, use and publish any of the images in any format taken of me on this day. I understand these images may be used for a variety of purposes and may appear on the club or district website, newsletter, promotional materials or any other media now known or to be invented. Since anyone can download an image from the Internet or make copies from printed materials, I agree that Circle K at UC Riverside is not responsible for unauthorized use of the images. I am aware that I am not entitled to any compensation and that the images may appear with or without my or my club’s name. *
A copy of your responses will be emailed to the address you provided.
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