Member Application

  • Full name of proposed member candidate, First, Mid, Last
  • Professional certifications (MD, CPA, JD, PhD, etc)
  • Date of birth needed so Rotary can calculate profiles of club demographics. The year will not be made public.
  • Address of proposed member (Street, Apt, etc)
  • Best email to reach you
  • Best phone to reach you
  • Name of business, organization, etc (where you work)
  • List your occupation, work title, etc
  • Work address of proposed member (Street, Apt, etc)
  • Best phone to reach you
  • List your occupation, work title, etc while you were working
  • List activities, professional affiliations that would enhance consideration as a Rotarian.
  • Name of current Rotarian proposing member candidate