We’re Glad You Are Here – Join a Civitan Family Club Today!

Thank you for choosing to be a Civitan!

Family dues may be paid annually, quarterly or monthly. One dues payment covers a family membership for all members of a household.

Monthly Family Dues: $15.00
Quarterly Family Dues: $45.00
Annual Family Dues: $180.00

Civitan Family Club - New Member Join Form

Name of Civitan Family Club you will join:

Primary Member Name(Required)

First Last

Primary Member Email(Required)

Primary Member Birthday(Required)

Primary Member Phone

Phone Type

Primary Member Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Who invited you to join?

(Sponsor)

Primary Member Spouse/Partner Name

Primary Member Employer

Additional Family Member #1

Full Name & Birthday

Additional Family Member #2

Full Name & Birthday

Additional Family Member #3

Full Name & Birthday

Additional Family Member #4

Full Name & Birthday

Additional Family Member #5

Full Name & Birthday

Family Dues Payment Plan(Required)

Total

If Paying by Credit Card

Credit Card Number

CVV

Expiration

Billing Zip

If Paying by ACH (bank draft/eCheck)

Routing Number

Bank Account Number

Bank Account Type

Recurring Payment Agreement

By checking the box below, you agree that a recurring payment to Civitan International will be automatically processed at the amount and frequency selected above until such time as you choose to end this membership.