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Electronic Membership Application Form

Hometown Civitan Club
Electronic Membership Application

Areas of Interest for Hometown Civitan Club Involvement

I hereby request membership in the Hometown Civitan Club. Upon acceptance, I agree to be subject to its by-laws and official policies.

I also agree to pay any dues to the club, region and Civitan International, as billed by the club (currently $150 per year).

By submitting this application electronically, my signature and date of application are confirmed.

I request that my personal information be used solely for communication within this club, region and Civitan International headquarters.

Thanks for submitting!

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