PROSPECTIVE MEMBER PROPOSAL
Email *
Proposer’s Name: *
Prospective Member's Name: *
Business Name: *
Business Address *
Business Phone *
Cell Phone *
Home Address *
Home Phone
Primary Email *
Secondary Email
Activities which would enhance consideration as a Rotarian:
If a former Rotarian, list club(s) and dates:
Profession at time of retirement:
Proposer’s Electronic Signature *
Date *
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A copy of your responses will be emailed to the address you provided.
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