APPLICATION for E-Satellite Membership

As part of the application process to become a Satellite Member of this Club, your application data will be distributed to the RECCO Board members and Provisional Members of the Satellite Club for approval.

Once approved it will go to the membership at large. Once you become a Satellite member, your data is collected and stored on our member only/password protected website (rotaryeclubcanada.ca). It is available to you at any time for you to manage. Only your contact information is available to other password accessed fellow members. All of your personal information on the website is available to selected club leaders. None of your private information, including contact information, is shared with any individual or organization that does not have access to our website. The handling of data is pursuant to legitimate interest for Rotary members, but where consent is required for this, by submitting this information with this form, you hereby give consent to this use and access.

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Once chartered as an E-Satellite Club Members will be registered as Active (Satellite) members with Rotary International and District 5370
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Upon becoming an E-Satellite Member you will also be asked to provide an Introduction speech to introduce yourself to other e-club members.

• Former Youth Exchange students, In or Outbound, Interactors, Rotaractors, Global Grant and Peace Scholarship Recipients, or any person between the age of 18 to 45 with the desire to to good in the world under the name of Rotary.

• Prospective Satellite Members who do not hold Active Membership in another Rotary Club wishing to explore the Rotary E-Satellite Club of Canada One, be involved in Committees Projects or propose projects in their own community under the name of Rotary before they decide whether or not to become an Active Satellite Member.

• Active Members between the age of 18 and 45 of another club wishing to be involved in the Rotary E-Satellite Club of Canada One, wishing to join a younger group of leaders and professionals must resign from their current club and request a transfer to the E-Satellite Club.

For more detailed information, Contact our Committee Member

Middle Name:

First Name: *

Last Name: *

Former or current firm of employment: Enter NA if not employed

Professional Position Held: Enter NA if not employed

I am a student *

YES NO

My Rotary Status *

I am former Youth Exchange Student I am a former Interactor I am a former Rotaractor I am a former Global Grant Recipient I am new to Rotary

Host Country: *

Sponsor Country *

Rotary Experience *

Phone Number *

Country Code Area Code Phone Number

E-mail Address: *

Confirm E-mail *

Mailing Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Other information you wish to share:

How did you hear about the Rotary E-Satellite Club? *

Activities that would enhance consideration as a Rotary E-Satellite Club Member: *

Are you prepared to take on a leadership Position in this club *

YES NO Maybe later

What is your preferred Method of Communication? *

Email WhatsAp FB Messaging (please ensure you have provided your FB link) Other

Admission Fee is Payable via Paypal

E-Satellite Members Admission Fee $ 25.00 CAD

We require that a photograph be submitted as part of the application *

By submitting this application I have agreed to all requirements and conditions *

I Agree

Application for Rotary E-Satellite Membership

Who qualifies for E-Satellite Membership?

All fields with * require text.

CONTACT INFORMATION. Please include country and area code in phone numbers

All applicants please complete ----

Admission Fee

Membership qualifications requirements