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Expression of Interest Form
Are you interested in joining Rotaract?
If so, please fill out the following form and join today!
(all this information will be kept confidential)
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Age
*
Your answer
Address and Suburb
*
Your answer
Phone number
Your answer
How did you find out about us
Facebook/Instagram
Email
Friend/Family/Co-worker
Rotaractor/Rotarian
Public advertisment
Other:
Preffered method of Contact?
*
Facebook/Instagram
Email
Phone
SMS
Mail
Other:
Required
What time is the best time to contact you?
*
Choose
Morning 9.00am - 11.00am
Midday 11.00am - 3.00pm
Afternoon 3.00pm - 6.00pm
Evening 6.00pm - 9.00 pm
Do you have a Current Working with Children's check If you don't the club will request you to get one.
Yes
No
Clear selection
Number and Expiry date
Your answer
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