Membership Proposal Form (application form)

 

 

Name (Please include applicable titles and/or suffixes.):

 

 

Current (or former) employer:

Position Title:

 

Home Address: (Include City/State/Zip):

 

            Telephone:

            Cell/Mobile phone:

            Email address:

 

Business Address (Include City/State/Zip):

 

            Telephone:

            Email address:

 

Preferred phone: □ Home   □ Cell/Mobile   □ Business

Preferred email:  □ Home   □ Business

Preferred mailing address:  □ Home   □ Business

 

Membership type proposed: □ Active   □ Honorary

Proposed Classification (Active only):

If a transferring or former Rotarian,

Previous Rotary Club:

Rotary membership ID number (if known):

Recent transfer (one year or less) □ yes   □ no

 

If an RI program participant or Foundation alum, list program(s) and date(s)

 

Activities that would enhance your consideration as a Rotarian (for honorary nominations, cite meritorious service):

 

 

 

Date of Birth (optional):

Spouse’s first name (if applicable):

Children's Names (and their ages if under 18):

 

Proposer’s Signature: ________________________________  Date: ___________

 

 

□ Approved   □ Not Approved

 

 

 

 

I hereby certify that I am qualified for (check one):

□ Active membership

□ Honorary membership

 

I prefer to receive the Rotarian magazine:

            □ Mail

            □ Digital

 

I understand that, if accepted for membership to the Rotary Club of San Marcos, it will be my duty to exemplify the Object of Rotary in all my daily contacts and activities and to abide by the constitutional documents of Rotary International and the club. I agree to pay membership dues in accordance with the bylaws of the club. I hereby give permission to the club to publish my name and proposed classification to its membership.

 

 

Proposed Member ’s Signature: ____________________________  Date: _______