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Rotary Membership Application
Thanks for your interest in Rotary Club 2677, District 6250. Please complete and submit this brief application so we can learn a little more about you.
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First Name
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Last Name
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Street Address
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City
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Zip Code
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Cell Phone
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Work Phone
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Email address. This will be used for communication from Rotary and for access to the website.
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Employer
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Date of Birth (MM/DD/YY)
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Spouse/Partner Name:
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Anniversary (MM/DD/YY)
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Have you been a Rotarian in the past?
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If you've been a Rotarian, when and where?
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Let us know your interests or hobbies -- or any other comments
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What would you like your membership badge to read? (Occupation, title, company, etc). Limited to 35 characters.
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How did you hear about our Rotary club?
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