RCWVS - Membership Proposal Form
Please complete the following new member proposal form.
NEW MEMBER CONTACT INFORMATION
First Name: *
Your answer
Last Name: *
Your answer
Home Address: *
Your answer
City: *
Your answer
Zipcode: *
Your answer
Email-Personal *
Your answer
Mobile Phone: *
Your answer
Home Phone: *
Your answer
Spouse's Name (If Applicable):
Your answer
Wedding Anniversary (If Applicable)
MM
/
DD
/
YYYY
BUSINESS & VOCATIONAL INFORMATION
Business Name: *
Your answer
Title/Position: *
Your answer
Services Offered: *
Your answer
Business Classification
Your answer
Business Address: *
Your answer
Email-Business *
Your answer
Business Phone: *
Your answer
COMMUNITY INVOLVEMENT & INTERESTS
Hobbies/Interests: *
Your answer
Community/Civic Groups: *
Your answer
Prior Rotary Involvement:
Your answer
COMMUNICATIONS PREFERENCES
Preferred Email: *
Preferred Phone: *
ACKNOWLEDGEMENTS
Name of Club Member Sponsoring This Application:
Your answer
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