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Colonie-Guilderland Rotary Club Membership Application
Please complete this form for each individual or business. Complete any questions that pertain to you.
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Enter your full name
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Your nickname
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Full home address (include street, city, state and ZIP code)
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Cell Phone #
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Home Phone #
Your answer
Work Phone #
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Email address
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Date of birth
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Birth place
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Please list current school and past schools you've attended. Please include dates attended, major, and degrees received.
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Spouse name (if applicable)
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Are you retired?
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If employed, enter your current employer
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Current job title
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Any special interests you have
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Community Activities
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How did you hear about Rotary?
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What attracts you to Rotary?
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If you're a prior Rotarian, please list where, when, and offices held (if any).
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Are you completing an individual or business membership application?
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