ROTARY CLUB OF NEW LONDON
MEMBER INFORMATION FOR DACdb System
|
|
ROTARY MEMBERSHIP APPLICATION
|
| |
Potential members are asked to complete the following information. Starred items(*) are required.
After completing this form, click 'Submit' and the Club you are requesting to join will receive your application. You can also print this form and mail it per your Club’s instructions. A copy of this application will be emailed to you.
|
| |
|
Member
|
|
|
|
|
|
|
Suffix:
|
|
|
|
|
*Gender:
|
|
|
|
|
|
|
Cell Carrier:
|
|
|
| |
|
Sponsor(s)
|
|
|
| |
|
Please check the below next to your preferred mailing address
|
| |
|
Home Address
|
|
|
|
|
|
|
State:
|
|
|
|
|
|
|
Country:
|
| |
|
Vacation Address
|
|
|
|
|
|
|
State:
|
|
|
|
|
|
|
Country:
|
| |
|
Business
|
|
|
|
|
|
|
|
|
|
Business Address
|
|
|
|
|
|
|
State:
|
|
|
|
|
|
|
Country:
|
| |
|
Spouse / Partner
|
|
|
|
|
Suffix:
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Previous Rotary Clubs
|
| |
|
Club 1
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
|
Club 2
|
|
|
|
|
|
|
|
|
|
|
|
|
| |
Club Participation / Achievements:
i.e., offices held in club and which year
|
| |
Bio / Description:
i.e., personal and professional background
|
| |
Degrees:
|
| |
Hobbies & Interests:
i.e., golf, fishing, and hunting
|
| |
Community Leadership & Other Comments:
i.e., community organizations you are involved with (board member, volunteer, etc), projects, organizations, subjects you could give a 30 minute talk to the club
|
| |
References:
|
| |
Why Do You Want to Join Rotary?
|
| |
To Be filled out by Club Secretary
(Check and complete appropriate boxes)
|
|
|
|
|
|
|
|
|
|
|
|
|