Rotary Alumni Data Form
Thanks for providing this information to update the Rotary Alumni database.
By completing this form you consent to the disclosure of this information to Rotary clubs and District committees in New Zealand and overseas for Rotary purposes only.
First Name *
Your answer
Preferred Name
Your answer
Family Name *
Your answer
Surname at time of Rotary program (if different from above)
Your answer
Gender *
Required
Date of Birth
Your answer
Rotary Status (choose those which apply)
Rotary Program (choose those which apply) *
Required
For Youth Exchange - note country / district hosting you
Your answer
For scholarships - note institution, course & country of study
Your answer
For Rotaract or Interact - note club name and district / country
Your answer
Program Year (for each program, if more than one)
Your answer
Program start and end dates (for each program, if more than one) - where you can remember. At least the year is helpful.
Your answer
Sponsor Club (for each program, if more than one)
Your answer
Current residential address (incl postcode) *
Your answer
Mobile phone
Your answer
Email address *
Your answer
Occupation
Your answer
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