Form
Rotary eClub of Houston All Club Survey 2022-2023
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
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Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Phone Number
Please enter a valid phone number.
Birthday
Where is your primary location or what time zone are you primarily located in?
Occupation
Areas of Interest/Hobbies
Rotary is dedicated to causes that build international relationships, improve lives, and create a better world to support our peace efforts and end polio forever. Which of the 7 pillars of Rotary are you most interested in?
Promoting Peace
Fighting disease
Providing clean water, sanitation, and hygiene
Aid for mothers and children
Supporting education
Growing local economies
Protecting the environment
Which committee would you be most interested in?
Membership (recruitment, retainment, processing applications, onboarding)
Club Services (newsletter, president's vlog, member spotlight, calendar updates, fellowship, vocation/networking)
Community Service (planning & promoting events, recognition)
International Service (planning and executing grants and projects)
Public Image (social media, content creation, SEO marketing, brand standards, general marketing)
Would you like to be featured in our Member Spotlight telling us about yourself, your career, interests, and/or highlighting any current community service or projects you participate in?
Please Select
Yes
No
Would you like to be a speaker in our Speaker Series? If so, what would your topic be?
What topics would you be interested in for our Speaker Series?
Fellowship - select your favorite areas of interest
Food & Wine
Books/Reading
Health & Wellness
Music
Other (please specify)
Why did you join the eClub?
Do you have any prospective new members? If so, please enter their information and our Membership Chair will contact you for an introduction.
How can our club best serve you - what would you like to get out of being a member this year?
The Rotary Foundation transforms your gifts into service projects that change lives locally and globally. Since it was founded more than 100 years ago, the Foundation has spent more than $4 Billion on life-changing, sustainable projects. The Rotary Foundation helps Rotary members to advance world understanding, goodwill, and peace by improving health, providing quality education, improving the environment, and alleviating poverty. Where does your money go - For as little as 60 cents, a child can be protected from polio. $50 can provide clean water to help fight waterborne illness. $500 can launch an antibullying campaign and create a safe environment for children. Every dollar counts, and we have a goal to encourage all members to give to the Foundation in big or small ways. What is your pledge for this year?
How do you prefer to make payments?
Please Select
PayPal
Venmo
Check
Other
Please select which days work best for you to attend meetings
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Please select what times work best for you to attend meetings
Morning (10am CST)
Lunch (12pm CST)
Afternoon (2pm CST)
Evening (6pm CST)
Evening (7pm CST)
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