Rotary Club Membership Application Form

Rotary Club

of

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

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!