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Rotary Club of East Jordan
East Jordan Rotary Club Application for Membership
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Guiding Principal of Rotary
First Name
*
Your answer
Last Name
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Your answer
Nickname
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Your answer
Address
*
Your answer
Birthdate
*
MM
/
DD
/
YYYY
Email address
*
Your answer
Phone number
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Your answer
Profession
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Your answer
Education history
*
Your answer
Partner
Your answer
Partner's Date of Birth (if Applicable)
MM
/
DD
/
YYYY
Wedding Anniversary (if Applicable)
MM
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DD
/
YYYY
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