Canadian New Member Addition Form | Civitan International

You may add up to 5 new members at one time using this form. Roster changes will be received and processed by World Headquarters, allowing new members to quickly start receiving Civitan International information, and be receive recognition. If you have any questions, please contact growth@civitan.org.

Canadian Member Addition Form

Club Name(Required)

Submitted By:(Required)

Name of club member completing this form

Submitter's Email Address(Required)

Form confirmation will be sent here

New Member Name(Required)

New Member Email Address(Required)

New Member Mailing Address

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

Sponsoring Member Name

Do you need to add a second new member?

Yes

New Member #2 Name(Required)

New Member #2 Email Address(Required)

New Member #2 Mailing Address

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

Sponsoring Member Name (New Member #2)

Do you need to add a third new member?

Yes

New Member #3 Name(Required)

New Member #3 Email Address(Required)

New Member #3 Mailing Address

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

Sponsoring Member Name (New Member #3)

Do you need to add a fourth new member?

Yes

New Member #4 Name(Required)

New Member #4 Email Address(Required)

New Member #4 Mailing Address

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

Sponsoring Member Name (New Member #4)

Do you need to add a fifth new member?

Yes

New Member #5 Name(Required)

New Member #5 Email Address(Required)

New Member #5 Mailing Address

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

Sponsoring Member Name (New Member #5)