Madison West Kiwanis Club Ron Schuler, Secretary 926 Arden Lane ...
M a d i so n W e st K iw an i s Cl u b R o n S ch u l e r, S ec r e t ar y 9 2 6 Ar d e n L an e, M ad i so n , W I 5 3 7 1 1 Ad m i n @ m ad i so n w es t kiw an i s . c o m
Membership Application Name:
___________________________________________
Nickname: ________________________
Address: ________________ City:
State: _________________________ Zip: _______
Home Phone: ___________________ Home email address ______________________________________________________________________ ___ Employer Name:______________________________________________________ Business Type___________________________________________ Business Address: ____________________________________________________ City: ______________________________________________________ State:______________ Zip: _____________________________________________ Position/Title: Business Phone:
Business Fax:
Business Email:
Business Website:
Education Background: _________________________________________________________________________________________________________ Birthdate: ______________________________________________________________ Spouse Name: _________________________________________ Where should we send mail? Home ___________ Business ______________ Email Preference: Home ____ Business __________ Have you belonged to a service club before? No ______________ Yes (when/where? Membership in Business or Professional Organizations: ____ ____________ __________________________________________________ Hobbies: __________________________________________________________ ____________ Which club committee would you prefer to serve with? Club Meetings and Administration _____ Membership Growth & Future Planning ____ Public Relations ____ Human & Spiritual Values ____ What do you see as the most important needs in our community right now? Applicant Signature __________________________________________ Date ____________________________________________________________ I am proud to sponsor the above candidate for membership in the Madison West Kiwanis Club: Preferred Induction Date:__________ Sponsor Signature_________________________
Membership Application Name:
___________________________________________
Nickname: ________________________
Address: ________________ City:
State: _________________________ Zip: _______
Home Phone: ___________________ Home email address ______________________________________________________________________ ___ Employer Name:______________________________________________________ Business Type___________________________________________ Business Address: ____________________________________________________ City: ______________________________________________________ State:______________ Zip: _____________________________________________ Position/Title: Business Phone:
Business Fax:
Business Email:
Business Website:
Education Background: _________________________________________________________________________________________________________ Birthdate: ______________________________________________________________ Spouse Name: _________________________________________ Where should we send mail? Home ___________ Business ______________ Email Preference: Home ____ Business __________ Have you belonged to a service club before? No ______________ Yes (when/where? Membership in Business or Professional Organizations: ____ ____________ __________________________________________________ Hobbies: __________________________________________________________ ____________ Which club committee would you prefer to serve with? Club Meetings and Administration _____ Membership Growth & Future Planning ____ Public Relations ____ Human & Spiritual Values ____ What do you see as the most important needs in our community right now? Applicant Signature __________________________________________ Date ____________________________________________________________ I am proud to sponsor the above candidate for membership in the Madison West Kiwanis Club: Preferred Induction Date:__________ Sponsor Signature_________________________
