Request For Membership Information   -- Wilmington Kiwanis

 If you are interested, simply print this page and fax it to our membership office at: (302) 325-0778 or contact us by email at KiwanisWilm@aol.com.

Name: ____________________________       

Company: _______________________
Address: __________________________       

Address: ________________________
City __________________________        

State _________________________ Zip ____________
Home Phone: ______________________       

Bus. Phone: _______________________
 

Fax #: ____________________________

Email address: _____________________       

Referred by: _______________________________________________________________________