ROTARY CLUB OF THE ATLANTA AIRPORT
Prospective members are asked to complete the information below. Starred items(*) are essential fields.
Application fee of $75 should be submitted along with application. Please submit application fee on our website on the membership page or via PayPal copy and paste this link in your browser for payment https://www.paypal.com/webapps/hermes?token=5YL06214265135457&useraction=commit&mfid=1670955332200_f85527169cf83
Prospective Member:
Name
First Name
Last Name
*Nickname (Badge name)
Date of Birth
-
Month
-
Day
Year
Date
Email
example@example.com
Please Check below to indicate which is your preferred mailling address.
Residence Address
Vacation Address
Residence Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Vacation Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
BUSINESS:
Company:
Occupation/Job Title:
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Ext:
Fax:
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
PO Box Address
Box Number
Street Address Line 2
City
State / Province
Postal / Zip Code
***Rotary International values family which is why we want to know yours*
FAMILY (Optional):
Spouse or Significant Other
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Married
Yes
No
ACHIEVEMENTS:
i.e.: offices held in club/ organizations and which year.
HOBBIES & INTRESTS:
i.e.: golf, fishing, and hunting
NOTES: i.e.: Community positions, projects, organizations, subjects you could give a 30 minute talk to the club.
****To be filled out by Club Secretary once member has been accepted*****
CLUB:
Classification:
*Member Type:
Active
Active – Rule of 85
Active – Leave of Absence:
Honorary
Paul Harris Fellow: YES
Paul Harris Fellow: NO
If yes, which Rotary year?
-
Month
-
Day
Year
Date
*Induction Date
-
Month
-
Day
Year
Date
Sponsor’s Name
PREVIOUS ROTARY CLUBS: *Rotary ID number
Name of Club
City/State
Date Joined:
-
Month
-
Day
Year
Date
Date Resigned:
-
Month
-
Day
Year
Date
Submit
Should be Empty: