Membership Application Form
Join the global movement of young leaders who are developing innovative solutions to the world’s most pressing challenges.
Who are we?
The Rotaract Club of Quezon City Congressional Dragons bring together people ages 18 to 45, young professionals and students to exchange ideas with leaders in the community, develop leadership and professional skills, and have fellowship through service.
How do I join?
Please Fill-out this Membership Application Form and one of our Membership Committee Members will message you.
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Address
*
Street Address
Barangay
City
State / Province
Postal / Zip Code
Mobile Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Alternate Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Active Email Address
*
example@example.com
Are you a Young Professional or a Student?
*
I am Student
I am Young Professional
I am a Working Student
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Which Rotaract's Avenues interests you? Select all that applies
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Club Service
Community Service
Community Service
Professional Development
International Service
Which 7 Causes of Rotary are you interested in? Select all that applies
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Promoting Peace
Fighting disease
Providing clean water, sanitation, and hygiene
Saving mothers and children
Supporting education
Growing local economies
Protecting the environment
Do you have a Rotary or Rotaract Background
*
Yes, I've been a member of a Rotaract Club before
Yes, I have a Rotarian/Rotaractor relative
No, I only heard of the organization before and I would like to join
No, it's my first time joining
Are you interested in taking a leadership role on the Board of Directors?
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Yes
No
Undecided
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Payment Details
Every member of the Rotaract Club has to pay an annual membership fee which also cover the annual Rotary International Due
How are you going to pay the membership annual due of ₱2,000.00
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I will pay annually (₱2,000.00)
I will pay semi-annually (₱1,000.00)
I will pay quarterly (₱500.00)
I will pay monthly (₱170.00)
Mode of Payment
*
Cash
GCash
Maya
Bank Transfer
What Social Media Accounts do you have?
*
Facebook
Instagram
Twitter
TikTok
SnapChat
Which Messaging App do you prefer?
*
Text Messaging
Facebook Messenger
Viber
Telegram
WhatsApp
Line
WeChat
Kakao Talk
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By signing this membership form you agree to the sharing your contact information with other members of Rotaract Club of Quezon City Congressional Dragons. Your information will not be shared outside of Rotaract Club of Quezon City Congressional Dragons. Further, I agree to allow photographs which may contain my image to be shared on social media and other by the Rotaract Club of Quezon City Congressional Dragons for the purpose of promoting our club and our events.
All information given above are in line with Republic Act No. 10173, also known as the Data Privacy Act of 2012 (DPA), aims to protect personal data in information and communications systems both in the government and the private sector. The DPA created the National Privacy Commission (NPC) which is tasked to monitor its implementation.
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I Agree
Signature
*
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