Membership Application

 

 

 

 

 

 

Northlake-Mandeville Rotary Club

 

 

Click to download New Member Application           

 

 

NEW MEMBER PROPOSAL FORM (Northlake-Mandeville Rotary)

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: ________________________________________

 

Personal Information:

Date of Birth:_______________  College attended: ______________________________

Residence Address:________________________________________________________

Home Phone: ______________________           Home Fax:  _______________________

E-Mail: _______________________________   Cell Phone: ______________________

Spouse's (Sig.Other) Name________________     Spouse's Date of Birth: ____________

 

Business Information:

Employer: _______________________________________________________________

Job Title:  _______________________________________________________________

Employer Address: ________________________________________________________

Business Phone: _______________________   Business Fax: ______________________

Website:________________________________________________________________

Business E-Mail:_____________________________ How long with employer:________

Previous Employer: _______________________________________________________

How long with previous employer? ____________

 

Club information:

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.