Charter Member Initiation Form

Charter Member Initiation Fee Form Page Header Image

Thank you for your interest in joining Civitan International!

This payment is for founding members joining a club during its Launch Phase working toward its official charter. If you are interested in joining an already established Civitan club, please email our team at growth@civitan.org.

Club Name to be Joined?(Required)

New Member Name(Required)

First Last

New Member Email(Required)

New Member Phone(Required)

New Member Address(Required)

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

DOB

Who invited you to join this club?

T-Shirt Size?(Required)

Do you have any comments?

Do you agree to joining this club?(Required)

Yes

Total

Credit Card

Cardholder Name

Card Details