Membership application form
Application for membership to the Rotary Club of Auckland

I acknowledge that the processing of my application will involve publication of my name and, accordingly, I authorise the Club to undertake any such publications.

I further acknowledge that membership of the Club is granted entirely at the discretion of the Board of Directors. The Board of Directors shall not be obliged to give reasons to me for either accepting or rejecting my application for membership.

Full name *
Your answer
Preferred name *
Your answer
Occupation *
Your answer
Job title *
Your answer
Business name (if any)
Your answer
Email address *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Mobile number *
Your answer
Work phone
Your answer
Home phone
Your answer
Preferred contact number *
Home address *
Your answer
Business address
Your answer
Life partner’s name (if applicable)
Your answer
Previous Rotary memberships (if applicable)
Your answer
I am interested in being involved in *
Required
CV provided *
If no, please email to office@aucklandrotary.org.nz
Your answer
Privacy statement *
PRIVACY ACT 1993 I, as a prospective new member in the Club, hereby agree that the Club may make such enquiries and receive such information about me as it deems necessary to assess my application for membership of the Club. I authorise the collection and use of such information in accordance with the Privacy Principles as set out in the Privacy Act 1993.
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