Rotary International of Scarsdale N.Y. 10583                               Membership Application
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I hereby certify that if accepted to Membership of the Rotary Club of  SCARSDALE, N.Y. 10583, that I as a Rotarian, will exemplify the Object of Rotary in all my daily contacts and will abide by the constitutional documents of Rotary International and the club. If accepted to membership I agree to pay dues in accordance with the bylaws of the club.    
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