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KIWANIS CLUB of CHRISTIANSBURG
P.O. BOX 313    CHRISTIANSBURG, VIRGINIA 24068

MEMBERSHIP APPLICATION (PLEASE PRINT and bring to a meeting)

NAME                                                                                            NICKNAME

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HOME ADDRESS                                                                          TELEPHONE #

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EMPLOYER & ADDRESS                                                              BUSINESS PHONE #

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TITLE/POSITION                              EMAIL ADDRESS                 CELL PHONE #

___________________________     __________________         ____________________________
WHERE WOULD YOU LIKE YOUR KIWANIS MAIL SENT? HOME BUSINESS or OTHER

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 ARE YOU A FORMER KIWANIAN? IF YES, WHERE HOW LONG

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NAME OF CLUB/CITY                                                                   HOW LONG

DATE OF BIRTH            SPOUSE/PARTNER NAME           ANNIVERSARY

___/___/___                    ______________________            ___/___/___

MEMBERSHIP IN BUSINESS AND/OR PROFESSIONAL ORGANIZATIONS:

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HOBBIES:

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FOR YOUR FIRST COMMITTEE ASSIGNMENT, WOULD YOU PREFER TO WORK WITH?

CLUB ADMINISTRATION (CLUB MEETINGS, PROGRAMS, MEMBERSHIP RECRUITMENT, EDUCATION, ETC.)

COMMUNITY SERVICE (DIRECT SERVICES TO CHILDREN, YOUTH PROGRAMS, COMMUNITY PROJECTS, ETC.) IN YOUR OPINION, WHAT ARE THE MOST IMPORTANT NEEDS COMMUNITY TODAY?
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OPTIONAL: IF YOU ARE A FORMER MEMBER OF KIWANIS OR ANY OTHER CIVIC CLUB, WOULD YOU LIKE TO LIST ANY ACTIVITIES OR PROJECTS YOU PARTICIPATED IN THAT YOU WOULD LIKE TO SEE OUR CLUB CONSIDER?

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INDUCTION POLICY: TWO MONTH'S DUES ($68) MUST ACCOMPANY APPLICATION. NEW MEMBERS WILL BE FORMALLY INDUCTED AFTER PAYING DUES UP TO OR PAST THE SECOND MONTH.

Signature: _____________________________________________    DATE: ___/___/___