Georgia Kiwanis New Club Charter Member online processing portal

* Required information

Personal Information

* First Name:
* Last Name:
* Email Address:
* Confirm Email Address:
* Address 1:
Address 2:
Address 3:
* City:
* State:
* ZIP Code:
* Phone:
Cell Phone:
*
Gender
- Male
- Female
Spouse/Partner Name
* Date of Birth
Promo Code

Enter Code: Apply

Fee

Type	Fee
New Member Add Fee	$100.00

Business Information

Company:
Job Title:
Address 1:
Address 2:
Address 3:
City:
State:
ZIP Code:
Fax:
*
Which address do you want your Kiwanis Mail to be sent?
- Home
- Work
*
Do you hereby agree to accept this application for membership and agree to conform to the bylaws of this club and comply with the obligations of membership as explained to me by my sponsor?
- Yes
- No

Optional Information

Do you have a Nickname you wish to include with the your membership Application
Do you have a club committee preference?
- Administrative
- Community Service

Sponsor Information

* Please write the name of the Kiwanian who is sponsoring you for membership?

Club You are Joining and Membership Type

Which new chartering Kiwanis club are you joining?
What type of club membership are you applying for?
- Regular
- Corporate

Payment

Payment Method

Pay with Credit Card

Payment Summary

Register

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