PA Rotary Membership form
Please fill out this information, you will be contacted by our membership team to discuss further next steps.  To discuss membership cost  or any other questions please reach out to   parotarymembership@gmail.com
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Port Arthur Rotary 100 Years

First and Last Name
Home Address
Home Telephone
Business/Employer Name
Position Title
email
Date of Birth
MM
/
DD
/
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Partners name

Previous Rotary Club
Personal Background that would relate to Rotary
I hereby certify that if accepted to Membership of the Rotary Club of
____________________ , that I as a Rotarian, will exemplify the Object of Rotary in all my
daily contacts and will abide by the constitutional documents of Rotary International
and the club. I agree to pay an admission fee and dues in accordance with the
bylaws of the club.
Type in your name if you agree with the above
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