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CORPORATE MEMBER APPLICATION
Instructions: Please complete all of the fields below. After all fields are completed, please submit your application for review. Thank You!
BUSINESS INFORMATION
Please Fill in with N/A for any questions Not Applicable
Company Name
*
Website URL:
*
Company Number
*
Current Business Address (Full Address)
*
0/255 characters
PRIMARY MEMBER INFORMATION
Full Name
*
Current Position/Title
*
Work Phone
*
Work E-mail
*
Home Phone
*
Home E-mail
*
DOB
*
Home Address (Full Address)
*
0/255 characters
Tell us a little about yourself and your company (This can be used on our website/member list - Should be Public info)
*
🛈
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
*
ROTARY CLUB INTEREST
Which Committees are you interested in serving? (someone from the committee will get back to you with more information)
*
Membership Recruitment
Membership Relations
Fundraising
Service Projects
Events
Speakers
Community
Farmers Market
Public Relations
Grants
Database
Website
Treasurer Assistant
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.
*
ADDITIONAL MEMBER INFORMATION
Instructions: All of the fields below are not required, but are available if you have anyone else from your organization that you would like them to be involved. Thank you!
Full Name
Current Position/Title
Phone
E-mail
DOB:
Spouses Name
Former Rotarian? If so, what club?
ROTARY CLUB INTEREST
Committee they would be interested in learning more about? (someone from the committee will get back to them with more information)
Membership Recruitment
Membership Relations
Fundraising
Service Projects
Events
Speakers
Community
Farmers Market
Public Relations
Grants
Database
Website
Treasurer Assistant
ADDITIONAL MEMBER INFORMATION
Full Name
Current Position/Title
Phone
E-mail
DOB:
Spouses Name
Former Rotarian? If so, what club?
ROTARY CLUB INTEREST
Committee they would be interested in learning more about? (someone from the committee will get back to them with more information)
Membership Recruitment
Membership Relations
Fundraising
Service Projects
Events
Speakers
Community
Farmers Market
Public Relations
Grants
Database
Website
Treasurer Assistant