Application for Rotary Club Washington Global (RCWG) Membership

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Thank you for your interest in joining our club. To apply for membership, please fill out this form and send a CV to RCWG Membership Chair Adrien Kay Lopez (adrienkay@gmail.com) and copying 2023/24 Club President Sarah Nadiv (sarahnadiv@gmail.com. Please note the following membership dues. If your application is accepted, you hereby agree to pay to the club $100 upon joining independent of when you join in the calendar year. Thereafter, you will be billed $250 per year in two installments: in June ($125) for July-December and in December ($125) for January-June. Reduced dues of $200 per year are available for members below 35 years of age and for spouses/partners of existing members. The club may change its dues in the future if the board so decides. Continued membership is contingent on being up-to-date on dues. Please type your initials in the box below to indicate your agreement.

I agree to the RCWG membership conditions. *

Title (Mr., Mrs., Dr., etc.)

First Name *

Last Name *

Gender

Male

Female

Other

Clear selection

Date of Birth

YYYY

Are you a Rotarian or former Rotarian? *

Yes

If a Rotarian/former Rotarian, provide RI ID number.

Name of former club (last club if multiple)

Are you a Rotary alumni (e.g., Interactor, Rotaractor, Peace Fellow, Ambassadorial Scholar)

E-mail address *

Preferred phone number *

Alternate phone (if applicable)

Preferred Mailing Address (not your email address, but a physical mailing address) *

If accepted as a RCWG club member, can we point to (and grab your photo) from your Linkedin profile (if you have one)?

Yes

Clear selection

Please indicate if the address is residential, business, or other.

Residential

Business

Other:

Clear selection

Job Title *

Name of business or organization

Classification (type of job/profession)

Option 1

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Briefly tell us how you heard about our club. *

Please tell us about yourself (short bio) *

Are you interesting in one or more service activities in particular? If so, please explain.

Are you interested in making a short presentation on your work or passion at a club meeting? If so, please indicate the topic.

Option 1

Clear selection

Do you have any comments or suggestions on priorities for RCWG?

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