To be completed by Milson Rotary Club member
who is sponsoring/proposing the new member
Name of proposed member
*
Postal address
*
Residential Address
*
If different to postal
Email Address
*
example@example.com
Date of Birth
-
Month
-
Day
Year
Phone number
*
Occupation
*
Business & Address (if applicable)
Spouse/partners name
Milson Rotary Club Member sponsors name
*
Sponsors comments in support of this membership application
Date
/
Day
/
Month
Year
Date
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Should be Empty: