KC Graduate Registration

*Required information.

This is a security field. If you want this form being sent leave the following email field blank:

Kiwanis Key Club / CKI Name *
Your Name *

Birth Date (mm/dd/yyyy) *
State *
Home Phone
Other Phone

Email *
Zipcode *
Mobile Phone
On Facebook

There is no cost to you to register or renew your membership in this program.

Membership is renewed annually. The KC Graduate Administrator will email you a Proof of Participation and Renewal Forms within 30 days of your renewal date. Please return promptly.

I understand that I give permission for contact information to be shared with Kiwanis Organizations.

Type Full Name *

To confirm that you are a person and not a machine filling out this form, please put the answer to the following math question into the space provided.