We Are Family Incentive Request

The club is entitled to a claim for each new member sponsored by a family member of Kiwanis. Please complete the form below and email to district@kiwanisecc.org

Date:Click or tap to enter a date.

Club Name:Click or tap here to enter text.

New member Name:Click or tap here to enter text.

New member #:Click or tap here to enter text.

Sponsor Name:Click or tap here to enter text.

Relationship to Sponsor:Click or tap here to enter text.

Date joined:Click or tap to enter a date.

Date Inducted:Click or tap to enter a date.

Your Name:Click or tap here to enter text.

Your Email Address:Click or tap here to enter text.

Amount requested $100 CDN ☐	or	$75 USD☐

Pay by Cheque:	Y☐	N☐

Your mailing address:Click or tap here to enter text.

Required if requesting fund transfer

Pay by Fund Transfer	Y☐	N☐

Name of Bank:Click or tap here to enter text.

Name on Account:Click or tap here to enter text.

Account #:Click or tap here to enter text.

Address of Bank:Click or tap here to enter text.

SWIFT Code:Click or tap here to enter text.