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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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* Required
First Name
*
Your answer
Last Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
E-mail (Rotary Communications will be sent here)
*
Your answer
Home Address
*
Your answer
City
*
Your answer
State
*
Choose
MN
IA
Zip
*
Your answer
Cell Phone (only if you can accept Rotary calls on your cell)
Your answer
Work Phone (only if you can accept Rotary calls at work)
Your answer
Employer (or Retired or N/A)
*
Your answer
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)
*
Choose
Small
Medium
Large
XL
2XL
3XL
4XL
5XL
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