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Membership Application Longwood Rotary Club
Membership Application
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Email
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Your email
Name
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Your answer
Date
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Employer
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Position/Occupation
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Office Mailing Address
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Home Address
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Phone numbers (Office/Home/Cell)
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Your answer
Preferred Email Address for Rotary Info
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Your answer
Spouse/Partner Name
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Birthdate
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DD
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Previous Rotary Membership/Involvement
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Hobbies, Interest, Volunteerism
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Name of Sponsoring Rotarian
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Additional Comments
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Interested in Corporate Membership?
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LRC offers reduced membership fees based on income level. Are you interested in hearing about this option?
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