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Expression for Membership
Expression for Membership
Name
(Required)
First
Last
Date of Birth
(Required)
MM slash DD slash YYYY
Partner's Name
First
Last
Your Address
(Required)
Street Address
Address Line 2
City
State
Postcode
Email
(Required)
Mobile
(Required)
Do you speak any language (s) fluently, other than English?
Are you a current or former Rotarian?
Current Rotarian
Former Rotarian
Have not been a Rotarian
what is your most recent club:
Employment Status
Full Time
Part Time
Self Employed
Studying
Retired
Other
Current or most recent employer
Current position or Position held
Contact Name
First
Last
Address
Street Address
Address Line 2
City
State
Postcode
Mobile Phone
Contact Email
Areas of interest – International service projects:
Water and sanitation
Maternal and childhood health
Disease and prevention
Areas of Interest – Vocational Programs:
Networking
Business Excellence
Pride in Workmanship
Areas of Interest – General
Environmental projects
Civic Pride-Parks Gardens Beautification
Peace and conflict resolution
Education – literacy and numeracy
Youth development programs
Food security
Poverty and homelessness
Please provide an indication of the positions you may be interested in:
President role
Secretary role
Treasurer role
Community director
International director
Fundraising director
Membership & Public Image
Youth director
Facebook admin and Webmaster
Risk Officer
Based on your experience
Consent
I agree to pay all subscriptions and fees when due, and accept the principles of Rotary as expressed in its objectives and submit to and agree to comply with and be bound by the * constitution and bylaws of this club, and on these conditions alone am entitled to the privileges of this club.
Name
(Required)
First
Last
Date
(Required)
MM slash DD slash YYYY
Membership
Important: Membership is not automatically granted into a Rotary Club. Your application will be submitted to the board of directors for approval, and can be subject to the objection of existing members in good standing
