Membership Application
Rotary Club of Eastern Independence.
Welcome to the Rotary Club of Eastern Independence! We are honored that you have chosen to request membership to our club. Please complete the application below and select "submit".
Full Name *
Your answer
Name of Sponsor *
Your answer
Home Address *
Your answer
Work Address *
Your answer
Please let us know where you prefer to receive Rotary related correspondence *
Work Email *
Your answer
Home Email
Your answer
Please tell us where you prefer to receive Rotary related email *
Let us know your requested industry classification
Example: Loan officer, Business Law, HealthCare, Business Development, Education, Marketing
Classification
Your answer
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