Membership Application for Daybreak Rotary
Tell us a little about yourself. This form will be submitted to the Daybreak Rotary membership chair, who will contact you to discuss your application.
Name
Your answer
Email Address
Your answer
Company Name
Your answer
Company Address
Your answer
Primary Phone Number
Your answer
Birth date
Your answer
Principal Activity of Occupation
In Rotary, members share information about their occupations, professional expertise, and training. Please include a description that matches your occupation rather than only listing your job title. If you are a personal trainer and fitness club owner, for example, you might list something more broad like 'health and wellness' rather than simply 'owner' or 'trainer'.
Your answer
Home Address
Your answer
Name and profession of spouse, if applicable
Your answer
Children
Your answer
Personal interests, hobbies, professional/charitable activities and community involvement:
Your answer
Sponsor (if you have one)
Your answer
I hereby certify that I am personally and actively engaged in the business or profession or professional activity covered by the classification that has been proposed for me, and that my place of business or residence is located within the territorial limits of the club or within the corporate limits of the city in which the club is located or within an immediately adjoining territory. I understand that it will be my duty, if elected, to exemplify the Object of Rotary in all my daily contacts and activities, and to abide by the constitution and bylaws of the club. I understand that part of my membership dues will provide me an annual subscription to the official magazine or an approved prescribed regional magazine as may be applicable. I agree to pay the admission fee of $50, and annual dues of $330 in accordance with the bylaws of the club. I hereby give permission to the club to publish my name and proposed classification to its members.
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