Membership Application

* Mandatory fields

Full Name:

Nickname:

Home Address:

Home Phone:

Cell Phone:

Email:

Birth date:

Spouse's Name:

Anniversary:

Names of Children:

Education:

Your interests & Hobbies:

Community Activities:

Business Name:

Industry:

Title:

Business Address:

Business Phone:

Business Email:

Business and/or Professional Organizations:

Will you be able to attend meetings regularly?*

Yes

Are you a former member? If yes, name of Club and City:

Dates of Membership:

Positions/ Activities in Club:

Annual Dues (Options) Please Choose One*

The club's fiscal year starts on October 1 of each year. The following lists the annual dues options:

Option 1: $650 (Includes dues and all meals)

Option 2: $600 (Includes dues and 20 meals)

Option 3: $150 (Covers dues only. Meeting meals are $25 each, paid at the meeting.)

All members are asked to make a $100 charitable contribution to the La Jolla Kiwanis Foundation in support of the Pancake Breakfast. Members will receive 12 event tickets. Checks for this contribution should be made payable to the La Jolla Kiwanis Foundation.

Sponsor - Print Name:

Phone:

Reference #1:*

Relationship:*

Phone:*

Reference #2:

Relationship:

Phone:

Reference #3:

Relationship:

Phone:

Are you human? Please type the characters.*

This helps us prevent spam, thank you.

This field should be left blank

Become a member today!

Join Here

MEMBERSHIP APPLICATION

Become a member today!

About

Events & Fundraisers

Let’s Make A Difference

Contact us

Let’s Make A Difference