Kiwanis Club Membership Application

• Member Application Personal Information
• To join the Kiwanis Club of South Lake you will need to complete and submit this application form. Once your form is submitted and your payment processed, your application will enter an application approval process. You will receive a confirmation email once your application has been approved. Access to member feature will be disabled until application is approved.

Membership

New Membership

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About You

Your Name(Required)

First Last

Nickname

Your Address

Street Address Address Line 2 City ZIP Code

Birth Date

MM slash DD slash YYYY

Gender

MaleFemale

Spouse / Partner Name

Preferred Method of Contact(Required)

EmailPhone

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone(Required)

Membership Type

Individual

Company/Organization

Company Name

Existing Member Sponsor

Committee Preferences

SLP (Terrific Kids, Key Club, Builder’s Club, Aktion Club)

Scholarships

Santa’s Hut – Parade

Social Events

Celebrity Golf Tournament

Media

Fund Raising & Events

Former Kiwanis Member?(Required)

Yes

No

Signature

By signing here you certify that the information provided on this form is accurate to the best of your knowledge