New Member Application

MEMBER:

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Cell *

Email *

SPOUSE:

Date of Brith *

Name *

First

Last

Spouse Birthday *

Wedding Anniversary Date *

BUSINESS:

Company Name *

Occupation/Title *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Website *

CLUB:

Member Nickname (for member badge) *

Classification *

Membership Type (check one): *

STANDARD (quarterly RI/District dues plus quarterly weekly meals billed in advance; 60% weekly attendance encouraged) BUSINESS (quarterly RI/District dues plus quarterly weekly meals billed in advance; may designate up to three employees to alternatively attend weekly meetings) FAMILY (quarterly RI/District dues plus quarterly weekly meals billed in advance; 60% weekly attendance encouraged from either spouse) SERVICE (quarterly RI/District dues plus one meal/month billed in advance; participate in one service project per quarter and serve on one Committee or Working Group) OTHER (Active - Rule of 85; Honorary)

Choose Any *

Paul Harris Fellow?

If yes, which Rotary year? *

Sponsor *

Submit