Rotary Ottawa South Family Membership Application Form

Family Membership Application / Demande de membre familiel

The Family Membership allows a member and a spouse/ partner to become active members of the Rotary Club of Ottawa South, through the established membership approval process. Each member has the same rights, privileges and responsibilities as every active member and so are encouraged to attend club meetings, participate on projects, vote on club matters, and serve as club officers and on club committees.

NOTE: This program does not apply to Corporate/Organizational Members.

This application is for individuals (over the age of 18 years of age) who are interested in becoming a family member. / Ce formulaire s'adresse aux personnes (de plus de 18 ans) qui souhaitent devenir membre familiel.

Name/Nom*

First Name/PrenomLast Name/Nom de famille

I am the spouse of Rotarian First Name Last Name.

Personal eMail/Courriel personnel

Work eMail/Courriel de travail

Home Phone Number/Numéro de téléphone résidentiel

Area Code/Code zonePhone Number/Numero de telephone

Work Phone Number/Numero de telephone au travail

Area Code/Code zonePhone Number/Numero de telephone

Mobile Phone Number

Area Code/Code zonePhone Number/Numero de telephone

Home Address/Adresse du domicile

Street Address/Addresse de rue

Street Address Line 2/Addresse de rue ligne 2

City/VilleProvince / Province

Postal Code / Code postalCountry/Pays

Work Address/Addresse de travail

Street Address/Address de rue

Street Address Line 2/Addresse de rue ligne 2

City/VilleProvince / Province

Postal Code / Code postalCountry/Pays

I prefer Rotary Correspondence be sent to/Je préfère que la correspondance soit envoyée à

My Work/mon travailMy Home/mon domicile

Birth Date/Date de naissance

MonthDayYear

I am/je suis

Retired or semi-retired/à la retraiteWorking/en train de travaillerAn entrepreneur/Un entrepreneurA student/Un élève

Please briefly describe your professional background and skillset./Veuillez décrire brièvement votre parcours professionnel et vos compétences.

Please briefly describe why you are interested in joining our Rotary Club?/Veuillez décrire brièvement pourquoi vous souhaitez rejoindre notre Rotary club?

0/2000

Please briefly describe your past involvement with the community and service?/Veuillez décrire brièvement votre implication passée avec la communauté et le service?

0/5000

Are you a past member of a Rotary Club?/Êtes-vous un ancien membre d'un Rotary club?

Yes/OuiNo/Non

If yes, name of club and location/Si oui, nom du club et emplacement

Are you a past participant in a Rotary International or Rotary Foundation program such as Rotary Youth Exchange?/Avez-vous déjà participé à un programme du Rotary International ou de la Fondation Rotary tel que Rotary Youth Exchange?

Yes/OuiNo/Non

If yes, which program and when?/Si oui, quel programme et quand?

To understand the benefits and responsibilities of membership and the operation of our club, be sure to review membership information on our website./Pour comprendre les avantages et les responsabilités de l'adhésion et le fonctionnement de notre club, assurez-vous de consulter les informations sur les membres sur notre site web.

Please confirm that you have read and understand the benefits and responsibilities associated with Rotary membership, and agree that as a member you will promote the ideals and values of Rotary./Veuillez confirmer que vous avez lu et compris les avantages et les responsabilités associés à l'adhésion au Rotary et acceptez qu'en tant que membre, vous ferez la promotion des idéaux et des valeurs du Rotary.

I understand/Je comprehends

Once you submit your application, we will contact you shortly to complete the membership process.

Une fois votre candidature soumise, nous vous contacterons sous peu pour terminer le processus d'adhésion.

Thank you!/Merci!