Club counselor request form
Club counselors can support clubs as they ask questions and work through processes designed to make themselves even stronger.
Would you like to receive a visit from your division's club counselor? Complete this short form.
What is your name?
What is your primary e-mail address?
What is your primary phone number?
(Please include area code)
How may we contact you to set up a visit?
Include either email, phone or both.
What is your position in your club?
Secretary, treasurer or secretary/treasurer
Membership committee chair
Other committee chair
Which Kiwanis club do you belong to?
Which district do you belong to?
K07 Illinois-Eastern Iowa
K11 Louisiana-Mississippi-West Tennessee
K17 New England and Bermuda
K18 New Jersey
K19 New York
K21 Eastern Canada and the Caribbean
K22 Pacific Northwest
K24 Rocky Mountain
K28 Western Canada
K29 West Virginia
K30 Wisconsin-Upper Michigan
K33 Andean and Central America
K54 Non-districted Latin America
K60 Ecuador (DIF)
Which division within your district do you belong to?
Describe why you are looking for a club counselor's support.
Please give as many details as possible. This information will be given to the club counselor.
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