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Home » Membership Application

Membership Application


Want to become a member of the Utica-Shelby club? Fill out the application form to begin the process.

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Member Type*
Why do you want to join?
(check all that apply)
Contact Information
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Preferred Address*
Address type
Phone type
Email type
Number of children at home ages
Birthday
MO./DAY/YEAR
Date joining club*
Primary employment

(check one, most recent employment if unemployed or retired)
(most recent employer if unemployed or retired)
Job classification

(check one)
Highest education attained
(check one)
Skill sets/Training
(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
Background Check Consent
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Date

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