Membership Information Request Form

Kiwanis is a global organization of volunteers dedicated to changing the world one child and one community at a time!

If you would like membership information simply complete the form below. We will follow up immediately with you and send along an information packet. Thank you.

First Name*:
Last/Family Name*:
Mailing Address*:
Mailing Address 2:
City*:
State/Province:
Postal/ZIP Code:
Country:
Telephone:
Fax:
E-mail*:
Company Name:
Job Title:

Yes: No: I am a current member who is moving to Yerington/Mason Valley area.

The above address is: Home or Business

How did you hear about us?

If this address is different from the one given above, please provide the:

Alternative Mailing Address:
City: State/Province:
ZIP/Postal Code: Country:

Yes No

Please e-mail an electronic file containing the information I requested. (The club listing is a word document. To view the brochure, you will need Adobe Acrobat Reader, to download a free copy click here.)

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