Rock Island Kiwanis Club Membership Form

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To help us support you, please provide the information below. We have clubs for every age and ability, but to become a member of Kiwanis you must be the legal age of adulthood in the state or country where the club is located.

Membership Type *

New Kiwanis Member

Re-instating Kiwanis Member

Transferring Kiwanis Member

Honorary Kiwanis Member

Corporate Kiwanis Member

Why do you want to join? (Check all that apply)

To help kids

Community involvement

Business networking

To make friends

Leadership skills

Other:

Prefix

Mr.

Mrs.

Ms.

Dr.

Rev.

None

Other:

Full Legal Name *

Preferred Name

Preferred Mailing Address *

Home Address

Work Address

Phone Number *

Home

Cell Phone

Work

Email Address *

Home Email Address

Work Email Address

Clear selection

Clear form

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