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Full Name
__________________________________________________Nickname
__________________________
Home
address___________________________________________________________________________________
_______________________________________________________________________________________________
Home
Phone___________________ Mobile Phone __________________ Spouse's
Name_____________________
Name & Age of Children
_________________________________________________________________________
College
or University
__________________________________________________ Degree
___________________
Occupation
___________________________________________ Title
_____________________________________
Company
Name_________________________________________________________________________________
Business Address
________________________________________________________________________________
_______________________________________________________________________________________________
Business
Phone ___________________ Fax Number ___________________
E-mail_________________________
Send Kiwanis Mail to:
Home _____ Work _____
Date
of Birth ___________________________________
If you are a
former Kiwanian: Club Name ___________________________________
Date Left ______________
Length of membership
______________ If you are a life member, life member #
__________________________
Other Service Club
Affiliations/Positions Held
_______________________________________________________
Committee
Preferences
___________________________________________________________________________
Induction
Fee
Dues:
$260 per year (pro-rated) - Special rate for
Young Professionals
Sponsor:
________________________________ Date Initiated:
__________________________
Kiwanis Club of San Diego
- 3276 Rosecrans,
Suite 202 - San Diego,
CA 92110
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