Test Page for Membership Application

First and Last Name(Required)

Nickname/Preferred Name(Required)

Date of Birth(Required)

Spouse's Name

If Applicable

Anniversary Date

If Applicable

Cell Phone Number(Required)

Email(Required)

Which Kiwanis Club were you previous a member of?

Who is your sponsoring Kiwanian?(Required)

What is your church affiliation?

If Applicable

How long have you lived in Bulloch County?(Required)

Where were you born and raised?(Required)

Where do you work?(Required)

If retired, please mark retired

What is or was your job title/occupation?(Required)

What are your hobbies or interests?(Required)

What causes are close to your heart?(Required)

What other volunteer work are you involved in?(Required)

What college or university did you attend?

If applicable

Kiwanis Club of Statesboro Membership Application