Membership – Annual Auto-Renewal

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Signup Date
MM slash DD slash YYYY
Name (type as you would like listed on your name badge)*
First Last
Company (as listed on name badge)*
Position/Title (as listed on name badge)*
Do you need a new/updated name badge?*
- Yes
- No
Chapter you would like name badge to be delivered to (Seattle, Bellevue, Tacoma.)
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Email*
Phone
Church
Membership location(s)*
- Bellevue
- Seattle
- Tacoma
I agree with KIROS' statement of purpose/core values, statement of faith, and guiding principles. (See link below.)*
- Yes
Click here to view KIROS' statement of purpose/core values, statement of faith, and guiding principles.
Please do not post my name on the KIROS membership list on the website/at events.
- Check this box if you do NOT want your name posted.

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Password

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