Northlake-Mandeville Rotary Club
Please return this form to the Club Secretary or Membership Chairperson. This proposal will be submitted to the Board of Directors as soon as possible after 3 meetings are attended. However, it may take several weeks to submit this matter to the Board for consideration, depending upon the proposal and the timing of the proposal.
Name (Full) of Proposed new member: ________________________________________
Date of Birth:_______________ College attended: ______________________________
Home Phone: ______________________ Home Fax: _______________________
E-Mail: _______________________________ Cell Phone: ______________________
Spouse's (Sig.Other) Name________________ Spouse's Date of Birth: ____________
Job Title: _______________________________________________________________
Employer Address: ________________________________________________________
Business Phone: _______________________ Business Fax: ______________________
Business E-Mail:_____________________________ How long with employer:________
Previous Employer: _______________________________________________________
How long with previous employer? ____________
Former Rotarian? ___No ___ Yes Club:______________________________________
Sponsor's Name: _________________________________________________________
How long has the sponsor know proposed member? _____________________________
Hobbies and Interest: ______________________________________________________
Your activities that would enhance consideration as a Rotarian: ________________________________________________________________________
Note: A photo for the website would be helpful.
NOTE TO SPONSOR: By sponsoring a member, you are vouching to the club membership that the proposed member is of good and proper character and good business or professional reputation. We are relying on you to sufficiently know the person you are proposing.