New Member Application
Complete this form to apply for membership in the Rotary e-Club of the Southwest USA
Apply for official E-Club Membership
"Service without Borders"

Please fill out this form as completely as possible.

Submission of this application establishes your approval for The Southwest USA Rotary E-club to contact your previous Rotary Club(s) (if any) to verify your current/previous good standing in Rotary, and/or to contact references provided by you.

It also establishes that you agree to have your name submitted to the E-Club BOD for approval and circulated to our E-Club membership for comment, as required by Rotary International and E-Club governing documents.

The Orientation Committee has set up a mentor management process that ensures that each new member has a mentor. The Committee will monitor the progress of the mentor/member process, with committee members emailing the mentor regularly for reports on progress and process. The Orientation Committee will outline (a) what we are asking each new member to do: to ensure the best results for communications and participation and (b) support our mentors in their guidance of the new member.

Fullname *
Please enter your first and last name
Your answer
Email
Please enter your email address
Your answer
Address *
Street number and name, City, State, Postalcode please.
Your answer
Telephone1 *
Best number to reach you.
Your answer
Telephone2
Your answer
DOB *
Date of Birth include mo/da/yr using the US date format
MM
/
DD
/
YYYY
Business/Work information
Company
Name of company or last employer. If retired indication RETIRED.
Your answer
Job Desc
Job title or profession
Your answer
Bus Phone
Your answer
Company Website
Your answer
Bus Address
Include street address, City, St, Zip, Country
Your answer
Interest
Briefly describe why you are interested in Rotary membership or affiliation.
Your answer
Status
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