Gold Coast Passport Rotary Club Membership Application Form

Gold Coast Passport Club meeting - PJ Party
Gold Coast Passport Rotary Club Membership Application

We welcome you as a new member. Please read below details, fill out the form, and sign.
Name *

First Name Last Name
E-mail *
example@example.com
Phone Number: *

Phone Number
Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Birth Date: *

Month Day Year
Occupation: Business Name/Employer:

How did you hear about Rotary?
or
If Transferring from another Rotary Club:
Rotary ID No:      Name of Club:
Former Rotary Youth or Scholarship program participant, list programs and year:
Club Participation:
Please indicate at least one area of service within the club you are interested to assist:
Membership Finance Foundation Customer Service Professional Development Admin Fundraising Public Relations Youth Social Media

Membership Payments:
Membership fees are applied in 6 month lots. Please indicate how you would like to pay.
Yearly Bi-annually (1 Jul - 31 Dec, 1 Jan - 30 Jun)
Membership Rules
I hereby certify that I am qualified for active membership by my current or former status as:
- An entrepreneur, business owner, professional, community leader, Rotary alumni
- I live or have a place of business within the Gold Coast.
I understand that, if accepted for as a member, it will be my duty to exemplify the Objects of Rotary in all my daily contacts and activities and to abide by the constitutional documents of Rotary International and the Club.

I agree that to fully benefit from being a Rotary member it would be my duty to involve myself in at least 40 community service hours per year in any charity of my choice or service projects of this Rotary Club or any other 20+ Rotary Clubs on the Gold Coast or around the World.

I agree to the commitment to pay the annual dues totalling $360 ($180 upfront in advance every 6 months (or part thereof) from 1st Jul to 31st Dec, and 1st Jan to 30th Jun BEFORE their commencment) that gives me membership in this Rotary club and access to 1000+ Rotary clubs across Australia and 35,000+ Rotary Clubs around the World to connect me with 1.2 Million Rotarians. This amount is non-refundable.
Please tick to agree *

I understand that upon my resignation from the Rotary club that all dues must be paid up in full until 30th June, or 31 December, and that I will provide a letter/email to the President notifying them in advance of these dates to allow for the termination process. I agree to inform the club of my resignation before the 30th June or 31st December deadline to avoid the roll-over into the next 6 month block. I understand that I may be photographed / filmed at Rotary Meetings, Events and Socials of which may be posted online via our Website or other Social Platforms (Facebook, Instagram etc) for other Rotarians and members of the public to view unless we’re otherwise informed to exclude you. I also, hereby give the Club permission to publish my name and proposed classification in the Rotary directory.
Once you submit your application, we will contact you shortly to complete your membership application process. Thank you!
Signature *

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Gold Coast Passport Rotary Club Membership Application

Membership Rules