Jim Thorpe Rotary - New Membership Application
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First Name *
Middle Name
Last Name *
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Email Address *
Date of Birth
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Spouse Name (If Applicable)
Employer Name
Position
Business Address
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Previous Rotary Club ( If Applicable)
Rotary Sponsor
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 I hereby certify that, if accepted to Membership of the Rotary Club of Jim Thorpe 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.  
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