DAVIS KIWANIS CLUB

Membership Application

NAME:________________________  NICKNAME:_____________________________________

HOME ADDRESS:__________________________  CITY___________State_____ZIP:_______

E-MAIL ADDRESS:_________________________  HOME TELE:________________________

BUSINESS NAME:___________________________TELEPHONE:________________________

BUSINESS ADDRESS:_____________________    CITY:________ ZIP:________________

YOUR BUSINESS TITLE:_____________________ SPOUSE NAME:_____________________

CHILDREN:____________none_____________     AGES:_____________________________

MY BACKGROUND________________________________________________________________

MAIL PREFERENCE:[ ]HOME  [ ]BUSINESS    FAX TELEPHONE:___________________

MY BIRTHDATE (year optional):____________  SPOUSE BIRTHDATE (year optional):_______

MARRIAGE ANNIVERSARY DATE (if applicable) ________________________________________

MY KIWANIS CLUB SPONSOR NAME (if any):___________________________________________

FORMER KIWANIAN?: [     ]YES     [     ]NO     IF YES, NAME OF CLUB:______________________

BUSINESS/PROFESSIONAL

ORGANIZATIONS:_____________________________COMMISSION,ETC.____________________

MY HOBBIES:____________________________________________________________________

REASON(S) FOR WANTING TO JOIN:_______________________________________________

WHAT DO YOU SEE AS THE MOST IMPORTANT NEEDS OF OUR COMMUNITY?_______________

ANY INITIAL PREFERENCE OF THE FIRST COMMITTEE ASSIGNMENT?    [     ]YES     [    ]NO

[     ]  CLUB ADMINISTRATION (Club meetings, Programs, Membership, Newsletter, etc.)

[     ]  COMMUNITY SERVICE (Services to children, seniors, youth, adults, etc.)

DATE:__________                  SIGNATURE:__________________________

Return this completed form to your sponsor or mail/e-mail  to an address below.

Kiwanis Club of Greater Davis  P.O. Box 2122   Davis, CA 95617  Attn: Membership Chairperson

 OR… E-mail: Kiwanis@cal.net  Website: www.daviskiwanis.com