New Member Application 2020-2021
We are very excited to have you be interested in joining the Kiwanis Club of Ellicott City! More hands within our club, allow us to make a larger impact within the Ellicott City and greater Howard County communities!

We kindly ask that you please provide the information below, which will be inputted into the Kiwanis International system. Once your information is inputted into the Kiwanis system, you will be assigned a membership number and start to receive all of the member perks including our Kiwanis magazine, emails to stay informed, as well as the opportunity to engage in opportunities throughout the world with fellow members.

Should you have any questions, please do not hesitate to contact President Jenn at
First Name: *
Last Name: *
Address: *
Preferred Email Address: *
Preferred Phone Number: *
Alternative Phone Number:
(Not required but some incoming members like to provide both a cellphone and home phone)
Birthdate: *
Occupation: *
Were you a former member of the Kiwanis family and participated in any of the below programs? *
(Check all that apply - this answer may qualify you for two free years of dues that are provided to former youth program members)
Spouse's Name:
(If applicable - as a family organization, we often try to include spouses and significant others when appropriate)
Do you have any questions about the Kiwanis Club of Ellicott City that you would like us to answer and/or do you have any other information that you wish to share with us?
By completing this application for membership, I agree to be an active participant of the Kiwanis Club by attending meetings, engaging in service, and paying the annual membership fee which has been communicated to me. *
(Please type your name or initials below to indicate your agreement)
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