Membership Proposal Form
(To be completed by a GNM Rotary Club Member when proposing a new member] I propose that:
Proposed Member's Name
*
Title [Mr, Mrs, Ms, Dr, Prof, Rev]
First Name
Last Name
Proposed Member's Email
*
example@example.com
Proposed Member's Gender
*
Female
Male
They prefer not to say
Their Home OR Business Address
*
Street Address
Street Address Line 2
Town or City
State / Province
Country Name AND Postal / Zip Code
Their Date of Birth
*
/
Day
/
Month
Year
Their Phone Number
-
Country Code
Phone Number
Proposed Membership Type [check one]
Honarary
Active
Are they a transferring, or former Rotarian?
Yes
No
If yes, please provide their Rotary ID [if known]
If yes, please provide Previous Club Details: including Club Name, Date Joined and Date Left/Transferred
If yes, are they a Recent Transfer [one year or less]?
Yes
No
If yes, are they RI Program Participant/Foundation Alumnus? List program & date:
Their Position or Job Title
Please list any activities that would enhance consideration of your candidate as a Rotarian?
Your Details [ie. proposing GNMRC Member]
*
Title [Mr, Mrs, Ms, Dr, Prof, Rev]
First Name
Last Name
Submit
Should be Empty: