Membership Proposal

This form is to be completed by an existing Rotary member. Alternatively, you may download and fill out this Membership Application v3. If you interested in joining Rotary, please Contact Us.

* indicates required field

Proposed member*

Proposed member's email address*

Title

Mailing Address

Phone - Residence

Phone - Business

Phone - Mobile/Other

Proposed Classification

If rejoining or a former Rotarian, list most recent club

Previous club dates

Previous Rotary membership ID

Recent Rotarian (one year or less)

If an RI program participant or Foundation alumnus/a, list program(s) and date(s)

Activities that would enhance consideration as a Rotarian

Rotarian acting as sponsor*