Membership Application

Member type

What group of the Kiwanis Club of Jasper are you interested in joining? *

Traditional Satellite

Member type *

New Kiwanis member Former Kiwanis member Current Kiwanis member Transferring Kiwanis member Honorary Kiwanis member Corporate Kiwanis member Former Service Leadership Program member

Former name (returning member whose name has changed)

Why do you want to join?

Check all that apply.

To help kids Community involvement Business networking To make friends Leadership skills Other

Sponsor name(s)

Contact information

Prefix

First / given name *

Middle name

Last / family name *

Preferred name

Preferred mailing address *

Home Work

Phone *

Home Work Cell

Email *

Home Work

Background information

Spouse / partner name

Number of children at home, by age

Birth to 5 6 to 12 12 to 15 15 to 18 19 to 21

Birthday *

Gender

Date joining club *

Languages spoken

Corporate boards or community groups you serve with or on

Philanthropic interests or charities you donate to

Hobbies you enjoy

Education

Highest education attained — check one.

Primary/Grade School Secondary/High School Tech/Business School Vocational/Trade school Assoc. Degree (2 yrs.) College/University (4 yrs.) Masters Degree Graduate/Professional Degree

Degree(s) earned

By completing this application for membership, I agree to conform to the bylaws of this club and comply with the obligations of membership as explained to me by my sponsor.

I understand I will be responsible for total annual dues of $720 for traditional members and $360 for satellite members. In the United States, $8 of a member's annual dues and fees is applied to a Kiwanis magazine subscription.

Member type

Why do you want to join?

Contact information

Background information

Primary employment

Job classification

Education

Skill sets / training

Signature