Become a Kiwanis Member

Name:*

Name of Member Applicant

Spouse Name:

Name of Member Applicant Spouse

Address:*

Home address of Member Applicant

City, State, Zip*

City, State, Zip

Business Name:*

Business Name

Business Address:*

Business Address

Your Business Role/Title*

Your Business Role/Title

Date of Birth (MM/DD/YEAR):*

Place of Birth:*

Email:*

Preferred Email address to receive Kiwanis Club communications.

How long has applicant lived in Joplin area?*

Church Membership:

Member of other organizations (Volunteer, Civic Groups, Societies, etc. Include offices held, past and present, if any):

Military Service (Rank, Branch, Approximate Date):

Primary Employment*

Education Attained*

Grade School
High School
Technical/Business School
Associate Degree
Baccalareate Degree
Master's Degree
Graudate/Professional Degree

Send Kiwanis Postal Mail to:*

If you are a former Kiwanian: Club Name and Date Left

Committee Preferences:

APPLICANT SIGNATURE. I 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 the membership committee.

Date of Applicant Signature (MM/DD/YEAR)*

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For Membership Committee use: Please state why the prospect would like to become a member of the Kiwanis Club of Joplin

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What do you feel the prospect's greatest contribution to the Kiwanis Club of Joplin would be?

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Proposed by (current member name) and date (MM/DD/YEAR)

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Second Sponsor (current member name) and Date (MM/DD/YEAR)

Approved by Membership Committee:

Date: (MM/DD/YEAR) _______________________________
Signed (Current Member) ________________________________________________________
Elected to membership Board of Directors on (MM/DD/YEAR) _________________________________________

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Kiwanis Club of Joplin Membership Form

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