Membership Application – Kiwanis Club of Greater Dover

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Name

First

Last

Preferred Name

Gender

Date of Birth

Address

Address Line 1

Address Line 2

City

State

Zip Code

Preferred Phone

Member Sponsor Name:

Comment or Message

Certification

I accept this application for membership and agree to conform to the bylaws of this club and comply with the obligations of membership as explained to me by my sponsor. $8.00 of the member’s annual dues and fees are applied to a Kiwanis magazine subscription. Membership fees are $175.00 annually. I will be mailing a check payable to Kiwanis Club of Dover to Sergio Rodriquez, 11 Pine Street, Dover, New Jersey 07801