Who is your Rotarian Sponsor? First Name Last Name Email Phone Number Home Address City State Postal / ZIPCode Company Name Company Address Company City Company State Company Postal / ZIPCode Send Rotary Correspondences to: Home Work Birthdate Why are you interested in joining our Rotary Club? Describe your past involvement with the community and service? Are you a past member of a Rotary Club? Yes No If yes, name of club and location: Are you a past participant in a Rotary International or Rotary Foundation program? Yes No If yes, which program and when? Are you applying for a Corporate Membership? Yes No Please confirm that you understand the privileges and responsibilities associated with Rotary membership, and agree to promote the ideals of Rotary and comply with the requirements of the Rotary Club. Yes No Send
