Daybreak Rotary Membership Application
Welcome!  We are excited to learn about you as a potential member of Daybreak Rotary.  Tell us a little about yourself. This form will be submitted to the Daybreak Rotary Membership Chair, who will contact you to discuss your application.
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Name *
E-Mail Address *
Company Name
Company Mailing Address
Phone Number *
Principal Activity of Occupation
In Rotary, members share information about their occupations, professional expertise, and training. If you are a personal trainer, for example, you might list something 'personal training' or something more broad like 'health and wellness'.
Home Address
Birthdate
MM
/
DD
/
YYYY
Personal interests, hobbies, professional/charitable activities and community involvement:
How did you hear about Daybreak Rotary?
Why do you want to join Daybreak Rotary?
Sponsor (if you have one)
Which committee(s) would you be interested in learning more about?
Please select all that interest you.  Committee assignments can be changed.
The Four-Way Test is a nonpartisan and nonsectarian ethical guide for Rotarians to use for their personal and professional relationships.  As a member I commit to the best of my abilities to:  
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I agree to pay the admission fee of $50, and annual dues of $400 in accordance with the bylaws of the club. Option to pay annually, semi-annually, or monthly. I hereby give permission to the club to publish my name and proposed classification to its members. *
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