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Waldo Brookside Rotary Club Membership Application
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* Indicates required question
Title (Mr./Mrs./Ms./Dr./Esq./Hon.):
Your answer
First Name:
*
Your answer
Last Name:
*
Your answer
Nickname:
Your answer
Gender:
Your answer
Date of Birth:
*
MM
/
DD
/
YYYY
Home Address:
*
Your answer
Mailing Address:
*
Same as home address
Other:
Email Address:
*
Your answer
Preferred email address for dues & billing purposes:
*
Email address given above
Other:
Mobile Phone No. (9 digits, with prefix):
Your answer
Other Phone No. (9 digits, with prefix):
Your answer
Spouse/Partner Name (first, last):
Your answer
Anniversary:
MM
/
DD
/
YYYY
Children's names & ages (if any):
Your answer
Are you an animal person?
Tell us about your pets!
Your answer
Education (school(s), degree(s)):
*
Your answer
What are your general interests/hobbies?
*
Your answer
Please list any other organizations of which you are a member, & how you are involved.
*
Your answer
Are you on social media?
*
Facebook
Instagram
LinkedIn
X (nee Twitter)
I am not on social media
Other:
Required
Rotary membership status:
*
I am a new member of Rotary.
I am transferring from another Rotary Club.
I am renewing my lapsed Rotary membership.
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