Lake Zurich Rotary Club New Member Application
Please fill out all fields and submit application. A representative of the member services team will be in touch to follow up. 
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Email *
Last Name, First Name *
Email address *
Phone Number *
Home Address *
City, State, Zip *
Business Name *
Business address *
Business Website 
Work Phone Number *
Birthday *
Spouse Name
Area(s) of Expertise  *
How did you hear about our club? *
Who referred you to our club? *
What do you hope to gain from membership in our club? *
By adding the date below and clicking submit, I acknowledge my submission of application for the Lake Zurich Rotary Club. *
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A copy of your responses will be emailed to the address you provided.
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