Kiwanis Club Information Request Form

Snail Mail To:

Please complete the following form if your would like to receive membership information about our Kiwanis Club and Kiwanis International. At the end of the form, please indicate how you would like the information sent (Electronic Mail, U.S. Mail, or a call from a member).

First Name:    Required

Middle Name:   

Last Name:     Required

Address1:      

Address2:      

City           Required

State          Required

Zip/Postal     Required

Country:       

Daytime Phone: 

Evening Phone: 

Fax Phone:     


Email Address: Required

How would you like us to provide you information?
 
Surface Mail   

Telephone      

Email           

Are you interested in joining a Kiwanis Club?

   YES

   NO 

Are you a member of another community service club?

   YES

   NO

If YES, indicate club name?  

Enter Comments Below:
If you are interest in another Kiwanis Club we will forward this information.

© Copyright 1998-2012 Kiwanis Club of Oroville, CA.