Organized 1919

Chartered 1921

Vidalia Kiwanis
Membership Application

Last Name:    
First Name:    
Middle Initial:    
Preferred Name:    
Resident Address:    
City:    
State:    
Zip:    
Mailing Address:    
City:    
State:    
Zip:    
Home Phone:    
Home Fax:    
E-Mail Address:    
Birthday:    
Anniversary:    
Spouse's Name:    
Spouse's Birthday:    
Business Name:    

Business Address:    

City:    
State:    
Zip:    
Business Phone:    
Business Fax:    
Billing Info     
Mailed to:    
Resident     Mailing     Business 

Former Kiwanian:   

    Yes                               No
If so, name of Club:   
Kiwanis Sponsor:   
Length of      Membership:   
Name of Children:   
Age(s) of Children:   
Membership(s) in      other Business &     Professional      Organizations:   
What would you prefer your first committee assignment in this Club be related to:
          Club Administration (Club Meetings, Programs, Membership  Growth, the Club Bulletin, etc.)
          Community Service (Direct Services to Community, Assistance in Solving Community Concerns, etc.)
What do you see as the most important need(s) of this community now?
Date: 
This information application blank is to be presented to each new member immediately after his proposal is accepted by the board of directors and is to be returned to the club secretary prior to the new member's introduction.
After reviewing all the above information for possible changes, please submit your application. Thank you for applying to the Vidalia Kiwanis Club.  We look forward to your membership.


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Kiwanis Club of Vidalia, GA
P.O. Box 1183 • Vidalia, GA 30475

Meeting Place: Captains Corner Restaurant, Vidalia, GA, Tues. 12 Noon

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