Membership Application
Your Name
*
First Name
Last Name
Preferred email
*
example@example.com
Mobile Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Home Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Work Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Which club are you submitting this information for?
*
Denver Metro South Rotary Club
Compass Club of Colorado (Satellite Club)
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mailing Address (if different from home address):
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Company Name
*
Work Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Website
Industry
Job Position/Title:
*
Number of years in this field:
Send Rotary Correspondences to:
*
Home
Work
Birth Date:
*
-
Month
-
Day
Year
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Marital Status:
*
Please Select
Single
Married
Partner
Prefer not to say
Spouse/Partner Name:
First Name
Last Name
Spouse/Partner Birth Date:
-
Month
-
Day
Year
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Anniversary:
-
Month
-
Day
Year
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Children:
Name and ages
Why are you interested in joining our Rotary Club?
*
How did you hear about our Rotary Club?
*
Are you a past member of a Rotary Club?
*
Yes
No
If yes, Join Date:
-
Month
-
Day
Year
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If yes, name of club and location:
If yes, Positions/Roles in club:
Are you a past participant in a Rotary International or Rotary Foundation program?
*
Yes
No
If yes, which program and when?
Describe your past involvement with the community and service?
*
Personal/Business Reference:
Reference Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Your Bio:
*
Photo/headshot for Club Directory:
Browse Files
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Hobbies/Interests:
*
Please confirm that you understand the privileges and responsibilities associated with Rotary membership, and agree to promote the ideals of Rotary and comply with the requirements of the Rotary Club.*
*
Yes
No
Signature
Submit
Submit
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