Membership Application to Rotary Club of Austin University Area

Membership Application for Rotary Club of Austin University Area
Name*

First NameLast Name
Preferred Name or Nickname
Date of Birth

MonthDayYear
Marital Status

MarriedWith a partnerNot marriedPrefer not to sayOther
Partner or Spouse's Name (if applicable)
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Preferred Phone Number*
Please enter a valid phone number.
Type of preferred number*

MobileHomeBusiness
Optional - Other Phone Number (Home, Business, etc.)
Please enter a valid phone number.
Preferred email address*
example@example.com
Secondary email address (optional)
example@example.com
Nature of Business or Career*
Employer or Firm*
Can be self-employed or retired
Business Address (optional)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Prior Service Clubs
For past Rotarians only: Number of years in Rotary and Rotary International Number
What about Rotary appeals to you?*
Why do you want to join the Rotary Club of Austin University Area?*
What strengths will you bring to the club?*
Which committees would you be interested in serving on, or areas where you would like to participate in?

ServicePublicity (social media, etc.)MembershipAdministration (helping with running the club)Speaker (helping to arrange speakers)Other
If elected to membership, I agree to conform to the constitution and bylaws of the Rotary Club of Austin University Area and Rotary International. I can and will regularly attend weekly meetings of the club and participate in club activities. I will pay all dues* in a timely fashion. As I am able, I will contribute to the Annual Program Fund of the Rotary Foundation and to Polio Plus. I am not a member of a similar service club.

* Dues are currently $140 semi-annually and include dues to Rotary International, Rotary District 5870 and a subscription to the Rotarian Magazine.
Consent to store and process personal information

By selecting this checkbox, you consent to allow our organization to store and process the personal information submitted above for the purpose of reviewing your membership application
Signature*

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Date of Application

MonthDayYear
Date
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