Rotary Club of Charlotte South
Membership Application 2024

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PERSONAL INFO
Full Name  *
Home Address *
Contact information - phone and email *
Family Information - Spouse, Partner, Children
If not applicable, please type N/A
 *
Birthday *
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DD
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YYYY
PLEASE LIST THREE PERSONAL REFERENCES
Name, phone and/or email
Reference 1 *
Reference 2 *
Reference 3 *
WORK AND SCHOOL
Occupation(s) *
Company Information - Position, Website, Office Phone, Address *
Education:  School / Degree / Years *
ALL THINGS ROTARY
Member from this Rotary Club that is sponsoring you. 
If more than one, please list. 
 *
Previous Rotary Club Information
(Rotary ID, Club Number, Club Name, Date joined and Date Resigned)
If not applicable, please type N/A
 *

Previous Rotary Club participation - offices held in club and which year(s)

If not applicable, please type N/A

PREVIOUS ROTARY CLUB REFERENCES
Please list their name, phone and/or email
Rotary Reference 1
If not applicable please type N/A
 *
Rotary Reference 2
If not applicable please type N/A
 *
Rotary Reference 3
If not applicable please type N/A
 *
GETTING TO KNOW YOU

Biography - please tell us a little bit about yourself! 

Personal, professional and charitable background

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Hobbies & Interests

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Community leadership and other projects you've been involved with. 

 *
Please list any subjects you could give a 30 minute talk on to the club.
 *

Why do you want to join Rotary?

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I understand that it will be my duty, if approved, to exemplify the Objects of Rotary in all my daily contacts and activities and to abide by the constitutional documents of Rotary International and the club to which I have applied. 

I agree to pay the established club dues timely and in accordance with club policy. 

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