Alumni Registration Form

Kiwanis Club of Culver

Supporting our youth since 1996.

P.O. Box 103

Culver, Indiana 46511

Community and Alumni Registration

Culver, Monterey, Aubbeenaubbee Alumni

or

Interested Non - Alumni

	Last Name:		Phone:
	First Name:		Email:
	Middle Name:		Grad. Year:
	Address Line 1:		Years Attended:
	Address Line 2:		Maiden Name:
	City:		Spouse:
	State:
	Zip Code:		Receive Mailings:

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