Want to become a member of the Utica-Shelby club? Fill out the application form to begin the process. "*" indicates required fields Step 1 of 5 20% Member Type* New Kiwanis member Former Kiwanis member Current Kiwanis member Transferring Kiwanis member Honorary Kiwanis member Corporate Kiwanis member Former Service Leadership member Why do you want to join? To help kids Community involvement Business networking To make friends Leadership skills Other (check all that apply)Former name (returning member whose name has changed) Other reason Sponsor name(s) Contact InformationPrefix Mr. Mrs. Ms. Dr. Rev. None Other Full Name* Preferred Preferred Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Address type home work PhonePhone type home work cell Email Email type home work Spouse/Partner name Number of children at home ages0 - 5 6 - 12 15 - 18 12 - 15 19 - 21 Birthday Month Day Year MO./DAY/YEARGender Date joining club* Month Day Year Languages spoken Corporate boards or community groups you serve with or on Philanthropic interests or charities you donate to Hobbies you enjoy Primary employment Agriculture/Forestry/Fishing Banking/Finance/Insurance Communications/Media/Marketing Construction/Extraction Education/Training Government/Public Administration Manufacturing Legal Hospitality/Food services Healthcare Non-Profit Maintenance Real Estate/Property Management Religion Science Transportation/Warehousing Wholesale/Retail IT/Tech Funeral/Death services Other (check one, most recent employment if unemployed or retired)Name of current employer (most recent employer if unemployed or retired)Job classification Elected Sales Freelance/Contract work Professional Retired Technical Partner/Owner Management Support/Administrative Other (check one)Highest education attained 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 (check one)Degrees earned Skill sets/Training Professional graphic design Videography/Film Public Relations Photography Social media Professional writing/editing Strategic planning CPA/Accounting Fundraising Event planning Youth mentoring Political experience Grant writing Legal degree Recruitment (check all that apply) 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. In the United States, US$8 of a member’s annual dues and fees is applied to a Kiwanis magazine subscription. Additional membership dues and fees will be charged.Membership Type Corporate Membership Individual Membership Background Check Consent I agree to the to submit to a background check.Signature*DateMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Δ
