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Join the Kiwanis Club of Greater Ybor City
Membership Application for the Kiwanis Club of Greater Ybor City
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* Indicates required question
First Name
*
Your answer
Middle Name or Initial
Your answer
Last Name
*
Your answer
Nickname
Your answer
Street Address
*
Your answer
City, State
*
Your answer
Zip Code
*
Your answer
Work Phone
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Work Email Address
Your answer
Personal Email Address
Your answer
Profession
*
Your answer
Were you in an SLP? (Verified SLP get a dues discount. Check all that apply)
*
Circle K International (CKI)
Key Club International
Keyettes, Keywanettes, or KIWIN'S
Builder's Club
Aktion Club
K-Kids
None of the above
Required
Kiwanis Sponsor (If none, enter None)
*
Your answer
Birthdate
*
MM
/
DD
/
YYYY
Gender
Your answer
Highest Education Level
*
Grade School
High School
Technical Certificate or other Career/Professional Training
Some College
Associates
Bachelors
Masters
Doctorate, Medical Doctor, Juris Doctorate
Areas of Interest (Check all that apply)
*
Service to Children
Service to Elderly
Environmental Issues
Networking
Learning about the Community
Club Leadership
Fundraising
Event Planning
Mentoring Children
Mentoring College Students
Other:
Required
Do you agree to pay the New Member Dues ($150 prorated based on month joining) and $150 annual member renewal dues to maintain your membership in good standing in subsequent years? Former SLP only pay $43 club fees.
*
Yes
No
Other:
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