Rotaract 5050 Information Survey
The goal of gathering contact information is to be able to maintain accurate membership information for both your club and the district and to share events and other communications from Rotary District 5050.
Email *
The information you provide will only be shared with your specific Rotaract Club and Rotaract District 5050. You can opt in to receive email communications for Rotary District 5050. Opting in to receiving District communications, the following information will be shared: First Name, Last Name, Email Address, Club.
First Name *
Last Name *
Date of Birth *
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/
DD
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YYYY
Which Rotaract club are you a part of? *
Street Number *
City *
Province/State *
Postal Code / Zip Code *
Phone number *
Preferred method of contact *
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This form was created inside of Big West Rotaract Foundation.