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Membership Application
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The Kiwanis Club Of Hagerstown
Full Name:
*
Your answer
Date of Birth:
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MM
/
DD
/
YYYY
Home Address:
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Your answer
Home Phone:
Your answer
Cell Phone:
Your answer
E-mail Address:
*
Your answer
Business Name:
*
Your answer
Job Title or Description
Your answer
Business Address:
Your answer
Business Phone:
Your answer
Preferred Phone:
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Choose
Home
Business
Cell
Where do you prefer Kiwanis related mail be sent?
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Choose
Home Address
Business Address
Spouse's Name:
Your answer
Anniversary Date:
MM
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DD
/
YYYY
Children's Names and Ages:
Your answer
Membership in Business, Professional, Church, and Community Organizations:
Your answer
Hobbies and Ineterests:
Your answer
Are you a former Kiwanian or transferring Kiwanian?
*
Choose
Yes
No
If yes, former club name and length of membership:
Your answer
Preference of Committee Assignments (select all you have interest in):
*
Administration and Meetings
Programs
Membership
Newsletter
Community Service
Fundraising
Youth Services
Required
Most important challenges in our community:
*
Your answer
Sponsoring Kiwanian:
*
Your answer
Application Date:
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MM
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DD
/
YYYY
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