Rotary Membership Application
By completing this application you agree to pay the club membership fee if your membership in the club is approved.
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First Name *
Last Name *
Date of Birth *
MM
/
DD
/
YYYY
E-mail (Rotary Communications will be sent here) *
Home Address *
City *
State *
Zip *
Cell Phone (only if you can accept Rotary calls on your cell)
Work Phone (only if you can accept Rotary calls at work)
Employer (or Retired or N/A) *
Shirt Size
If your membership in our Rotary Club is accepted, the club will provided you a polo shirt at no charge. Please indicate what shirt size you would like below.
Polo Shirt Size (Adult Sizes) *
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