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Lake Zurich Rotary Club New Member Application
Please fill out all fields and submit application. A representative of the member services team will be in touch to follow up.
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Email
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Your email
Last Name, First Name
*
Your answer
Email address
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Your answer
Phone Number
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Your answer
Home Address
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Your answer
City, State, Zip
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Your answer
Business Name
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Your answer
Business address
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Your answer
City, State, Zip
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Your answer
Business Website
Your answer
Work Phone Number
*
Your answer
Birthday
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Your answer
Spouse Name
Your answer
Area(s) of Expertise
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Your answer
How did you hear about our club?
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Your answer
Who referred you to our club?
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Your answer
What do you hope to gain from membership in our club?
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Your answer
By adding the date below and clicking submit, I acknowledge my submission of application for the Lake Zurich Rotary Club.
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A copy of your responses will be emailed to the address you provided.
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