Are you interested in joining a Kiwanis club or forming a club in your community?

Please complete the following form, which will be forwarded to the District Secretary at the Kiwanis District Office of Australia.

First Name:

     Surname     

Address:

City

State:

Postcode:

Telephone

Fax:

Mobile:

Email Address

Company Name

Job Title:

Is mailing address your home or work?

Home Work

How did you hear about Kiwanis?

Meeting time Preference         Morning Evening

Would you prefer a club near your home or work?         Home Work

If this address is different from the one given above, please fill in the following information

Address

City

State

Postcode:

Hobbies/Interests

Other organisations to which you belong

Best time to call: