Key Leader Registration

Registration is due September 15, 2023.

Name(Required)

First Last

Preferred Name

For Name Badge, if applicable.

Registering as:(Required)

Have you attended Key Leader before?

Address(Required)

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

Email(Required)

Phone(Required)

Gender(Required)

Date of Birth(Required)

T-Shirt Size(Required)

Any special dietary or physical needs?

(i.e., Peanut Allergy, Vegetarian, Wheelchair accessible room)

Preferred Roommates

School(Required)

Graduation Year(Required)

I am a member of:(Required)

Key Club

Kiwanis

None of the above

Key Club Advisor's Name

Emergency Contact(Required)

First Last

Emergency Contact Relationship to Participant(Required)

Emergency Contact Email(Required)

Emergency Contact Phone(Required)

Total Online Payment

Coupon Code

New England & Bermuda District of Kiwanis