Rotary Club Membership Application Form

Rotary Club

of

South Rankin County
Complete the form below to apply to membership in our Rotary Club.

Who is your Rotarian sponsor or reference?

Name*

First NameLast Name

Phone Number*

E-mail Address*

Home Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Birth Date:

MonthDayYear

Why are you interested in joining our Rotary Club?

Describe your past involvement with the community and service?

Are you a past member of a Rotary Club?

YesNo

If yes, name of club and location:

Are you a past participant in a Rotary International or Rotary Foundation program?

YesNo

If yes, which program and when?

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

Thank you!