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*Required information.
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 *

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