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New Member Application
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Email
*
Your email
Thank you for your interest in joining our club! We are excited to get to know you!
Your First & Last Name
*
Your answer
Rotary Member Sponsor (name of person sponsoring you for membership):
*
Your answer
Your Date of Birth
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MM
/
DD
/
YYYY
Your Place of Birth
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Your answer
Employer (or self if self-employed)
*
Your answer
Your Title at Your Company
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Your answer
Business Address
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Your answer
Business Phone Number
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Your answer
Residence Address
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Your answer
Telephone Number (best number to reach you)
*
Your answer
Spouse/Partner's Name
Your answer
Children's Name(s)
Your answer
Hobbies & Leisure Activities
Your answer
Community Activities (past or present)
*
Your answer
Previous Rotary Affiliation?
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Yes
No
If above answer YES, when did you join and which club?
Your answer
Rotary Interests
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Fundraising
International Service
Community Service
Youth Services (Scholarships, etc.)
Club Activities/Events
Marketing
Other:
Required
Talents or skills you'd like to share with the club or enhance by participating in Rotary?
Your answer
Rotary membership you are interested in
*
Individual Membership with Meals: $205/quarter (includes weekly luncheons, Rotarian Magazine, dues to Rotary International & Rotary District 5450)
Individual Membership without Meals: $75/quarter (includes everything above except pre-paid lunches)
Spousal Membership: $205/quarter (same as individual membership but either spouse use the pre-paid meal each week)
Corporate Membership: $250/quarter (similar to individual membership, but any one member from the corporation or business may attend weekly luncheons; business is advertised on the clubs website; club decal for business window)
Required
Electronic Signature - please print your name to complete the application. Thank you!
*
Your answer
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