Summerland Rotary Membership Application
Please complete this application for membership to the Summerland Rotary. This application will be reviewed by a panel and the outcome will be shared with you.
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Type of application: *
Full Name *
Common Name
Date of Birth *
MM
/
DD
/
YYYY
Occupation *
Employer
Rotary Sponsor Name
Have you been a Rotary Member previously? *
If yes, where?
Home Address *
City *
Postal Code *
Primary Email *
Alternative Email
Home Phone *
Mobile Phone *
Business Address *
City *
Postal Code *
Business Phone *
My preferred phone number is... *
My preferred mailing address is... *
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