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Membership Application
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Today's Date:
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Name
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Address
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Phone
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Preferred Email
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Business Name
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Job Title
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Club Sponsor
The person that introduced you to Rotary.
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Second Language
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List any previous Rotary memberships, positions, and awards.
Please provide the number, city and state.
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Select Your Membership
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Basic Quarterly Membership ($110)
Basic Annual Membership ($430)
Would you like to support Polio Plus?
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I would like to donate Quarterly ($8)
I would like to donate Annually ($30)
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