Become a Kiwanis Member

Member Type*

New Kiwanis Member
Transferring Kiwanis Member
Corporate Kiwanis Member
Honorary Kiwanis Member

Why Do You Want to Join Kiwanis Club of Glendale Heights (Check all that apply)*

Select All
To Help Kids
Community Involvements
To Make Friends
Business Networking
Leadership Skills

CONTACT INFORMATION

Prefix

First Name*

Last Name*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone Number

Cell Phone Number

E-mail address

Best Time to Connect with You*

Morning
Afternoon
Evening

How do you prefer to be contacted?*

Home Phone
Cell Phone
E-mail

Background Information

Spouse/Partner Name

Prefix First Last

Number of Children at Home Ages 0-5*

Number of Children at Home Ages 6-12*

Number of Children at Home Ages 13-15*

Number of Children at Home Ages 16-18*

Number of Children at Home Ages 19-21*

Your Birthdate*

Gender*

Languages Spoken

Corporate boards or community groups you serve with or on

Philanthropic interests or charities you donate to

Hobbies you enjoy

Primary Employment*

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

Name of current employer (most recent employer if unemployed or retired)

Job Classification

Education

Skill sets/Training (check all that apply)*

How did you hear about us?*

Consent

I agree to the privacy policy.

Thank you for your interest in our club. We'll be in touch soon!
By clicking the submit button, you are giving permission for our Membership Chairperson to contact you via your preferred method (phone, email, etc.) solely for purposes of providing information about club membership. Your contact information is only retained for a period of 3 months and then discarded. It will never be sold to a third party or shared in any way without your permission.

Thank you and Welcome!

We will be contacting you soon!

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New Member Application

CONTACT INFORMATION

Background Information

Thank you and Welcome!