Rotary Club Membership Application Form

Rotary Club of Point West - Sacramento ApplicationComplete the form below to apply to membership in our Rotary Club.

A newer version (https://form.jotform.com/222671069537158) was created by someone, but no one knows where the results are sent. The previous version created by George Daniels was reinstalled 3/8/2023

This new member application was originally developed by George Daniels 4/27/2018. It is routed to the membership committee via email Membership@PointWestRotary.com which is distributed to committee members listed in the routing for the email. The routing can be update in the club's GoDaddy "Workspace Email" area. As of March 2023 these are the people who receive the new member application data: mather.joanie@gmail.com,tom.cicchini@raymondjames.com,beaba@themaurers.net,dominicporrino@gmail.com,george@ifonlyinc.com

Collected data (new member applications) are stored in Google Sheet https://docs.google.com/spreadsheets/d/10PHMB3VJN1cJ_UPlpj2U_1CgyUfyrHRNBbxmuUC_bHY/edit#gid=1003485490

First Name*

Middle Name

Last Name*

Nickname (for your badge):*

Birth Date:*

MonthDayYear

Home E-mail*

Work E-mail*

Preferred Email*

HomeWork

Home Phone Number:*

Area CodePhone Number

Work Phone Number:*

Area CodePhone Number

Mobile Phone Number:*

Area CodePhone Number

Preferred Phone*

HomeWorkMobile

Home Address:*

Street Address

Street Address Line 2

CityState

Zip Code

Business Name*

Type of Business*

Position/Title*

Business Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

website

Send Rotary Correspondences to *

WorkHome

Spouse/Partner

First NameLast Name

Spouse/Partner Birthday:

MonthDayYear

Wedding Anniversary

MonthDayYear

Children (Name, Gender & DOB)

Children: Add a new row for each child

Military Veteran*

YesNo

Branch

Rank

Sponsor #1*

Sponsor #2*

Personal Interest*

Past Rotary Club*

YesNo

Club Name

Rotary Number

Classification (for your badge)*

Membership Type*

RegularStudentHonorary

I have read the Member Participation and Cost Checklist and I agree with the financial and participation requirements outlined in the Checklist. I have completed the Activity Participation Questionnaire and will submit it with my initial dues and initiation fee.

Yes

Please confirm that you understand the privileges and responsibilities associated with Rotary membership, and agree to promote the ideals of Rotary and comply with the requirements of the Rotary Club. DATA COLLECTION: I consent to the collection, storage, and use of my information by Rotary Club of Point West as described in the Privacy Policy located at: PointWestRotary.com *

Yes

Once you submit your application, we will contact you shortly to complete your membership application. Thank you!

Signature

Clear

For more information contact the Point West Rotary Membership Committee at: Membership@pointwestrotary.com