South Austin Rotary Membership Application

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Email

example@example.com

Phone Number

Please enter a valid phone number.

Date of Birth

Date

Prior Rotary Membership?

YesNo

Profession

Work Title

Areas of passion of service (check all that apply)

Hobbies/Interest

Other non-profit involvement

Military Service

YesNo

By submitting this application, indicates that I understand:

My application will be circulated among Board members and my name will be circulated among club members for a vote on my application for membership and I recognize that my application may be rejected for whatever reason deemed appropriate by the organization.

In addition, I anticipate the expenses and attendance requirements listed on the Obligations of Membership (listed on website) and someone from the club has gone through those with me.

South Austin Rotary Membership Application

Rotary Experience

Professional Info

Passions/Interest