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Rotary Club of Community Action: New Member Form
Applications are reviewed by the Board of Directors each month.
Prospective members are encouraged to visit the club before application review. A one-to-one introduction is also encouraged. Contact ericmaul@me.com for more information.
Meeting information can be found at:
www.rotarycca.org
.
The following information will be used for your induction and the Rotary International Roster).
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Preferred Name
*
Your answer
Email
*
Your answer
Home Address (Street, City, State, Zip)
*
Your answer
Cell Phone
*
Your answer
Employer
Your answer
Work Address (Street, City, State, Zip)
Your answer
Work Phone
Your answer
Job Title
Your answer
Birth Date
*
MM
/
DD
/
YYYY
Spouse's Name (if applicable)
Your answer
Spouse's Preferred Name
Your answer
Special Interests or Hobbies
Your answer
Community Activities
Your answer
What attracts you most about Rotary?
*
Your answer
Other information that you would like to share?
Your answer
Have you served in Rotary before, if so, where/when?
Your answer
Rotary Positions (if former/current member)
Your answer
Sponsor's Name
*
Your answer
I understand that the Rotary Club of Community Action is a dues paying organization and that I will be billed once a year or monthly. (Currently $400 a year or $40/month)
*
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