KIDS Club Membership Form
Surname *
Your answer
First Name *
Your answer
Middle Name
Your answer
Nickname *
Your answer
Birthdate *
MM
/
DD
/
YYYY
Home Address *
Your answer
Telephone Number
Your answer
Mobile Number *
Your answer
Email Address *
Your answer
Occupation
Your answer
Business Name and Address
Your answer
Hometown
Your answer
Preferred Committee *
(Choose at most three (3))
Required
I am aware that this is a voluntary organization. *
I will adhere to the club's goals and policies. *
I will take part in the Club's meeting and projects. *
I understand that i need to share some of my financial and in-kind resources for the success of the Club's activities and projects. *
I understand that i need to shoulder my own travel and other expenses when i participate in the Club's activities and projects. *
I am willing to pay my membership dues in order to support the Club's activities and projects. *
I hereby agree that all information i have written in this form is true, accurate and correct to the best of my knowledge. *
Required
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