NEW MEMBER APPLICATION

Instructions: Please complete all of the fields below. After all fields are completed, please submit your application for review. Thank You!

MEMBER INFORMATION

Please Fill in with N/A for any questions Not Applicable

First & Last Name *

Current Home Address (Full Address) *

0/255 characters

Home Number *

Mobile Number *

E-Mail Address *

DOB *

Tell us a little about yourself (This can be used on our website/member list - Should be Public info) * 🛈

BUSINESS INFORMATION

Please Fill in with N/A for any questions Not Applicable

Business Name/Company Name *

Current Position/Title *

Primary Occupation & Industry *

Company Address (Full Address) *

0/255 characters

Office Number *

Fax Number *

Work E-Mail Address *

ROTARY INFORMATION

Please Fill in with N/A for any questions Not Applicable

Current Member of a Rotary Club? *

YES

NO

Former Member of a Rotary Club? *

YES

NO

Name of Club *

City *

SPOUSE/PARTNER INFORMATION

Please Fill in with N/A for any questions Not Applicable

Name *

Birthdate *

Anniversary *

COMMUNITY SERVICE HISTORY & ROTARY CLUB INTEREST

Please Identity the organizations in which you have previously served *

Why are you interested in Joining Rotary? *

Who was your sponsor to Rotary or what is your connection to Great Falls? *

Which Committees are you interested in serving? (someone from the committee will get back to you with more information) *

Is there anything that could be deemed "unethical" in your background that you would like to disclose to us now? Please note that all submissions are kept under strict confidentiality as we strive to build a Rotary Club with the highest standards. *