Nebraska/Iowa Key Leader Registration
First Name
Your answer
Last Name
Your answer
Address 1
Your answer
Address 2
optional
Your answer
City
Your answer
State
Your answer
Telephone Number
xxx-xxx-xxxx
Your answer
Zip
Your answer
Cell Phone Number
optional
Your answer
Email Address
Your answer
Name of School
Your answer
Year in School
What grade will you be in while at camp?
Date of Birth
MM
/
DD
/
YYYY
Gender
Tee Shirt Size
How did you hear about Key Leader?
Are you a member of Key Club or Builders Club?
Sponsoring Kiwanis Club, other organization/individual
Who is paying for you to attend Key Leader?
Your answer
Sponsor Name
Contact person in sponsoring organization
Your answer
Sponsor Mailing Address
Mailing address of Sponsor
Your answer
Sponsor Email Address
Your answer
Sponsor Telephone number
Your answer
Additional Sponsor Name
Your answer
Additional Sponsor Email Address
Your answer
Additional Sponsor Telephone Number
Your answer
Do you have any special needs we should tell the camp about?
dietary or physical
Your answer
Emergency Contact Name
Your answer
Emergency Contact Telephone number
Your answer
Emergency Contacts relationship to registrant
Your answer
Will you use the Bus Transportation from Omaha or Lincoln?
There will be bus transportation available, departing Friday, returning on Sunday.
Registration Type
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