NORTHLAKE-MANDEVILLE ROTARY CLUB #03990 - Mandeville, Louisiana

John Allan
John Allan
Rotary International
District 6840

Print this page

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: ______________________


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.




Meeting Time & Location Information
Beau Chene Country Club
602 North Beau Chene Drive
Mandeville, LA 70471  map it
Contact Information
Tom Quinn
phone: 985 789-2316
contact us

Please Check the Program & Events Calendar Tab to see our upcoming roster of guest speakers.


Site Content and Photographs ©2018  Northlake-Mandeville Rotary Club - Club # 3990.  All rights reserved.

Website application developed and hosted by RUSHweb Solutions.