Kiwanis Club Membership
Information Request Form

Cal-Nev-Ha District Division 14

Division 14 Membership
Attn: Ron Severson
P.O. Box 2092
Oroville, CA 96965-2092

Please complete the following form if your would like to receive membership information about our Kiwanis Club and Kiwanis International. At the end of the form, please indicate how you would like the information sent (Electronic Mail, U.S. Mail, or a call from a member). 

First Name:       
Middle Name:   
Last Name:     
Address1:      
Address2:      
City           
State          
Zip/Postal     
Country:       
Daytime Phone: 
Evening Phone: 
Fax Phone:     
Email Address: 

How would you like us to provide you information?
Surface Mail   
Telephone      
Email           

Are you interested in joining a Kiwanis Club?
YES
 NO
 
Are you a member of another community service club?
YES
NO

If YES, indicate club name?  
Enter Comments Below:

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