Membership Application to Rotary Club of Austin University Area

Membership Application for Rotary Club of Austin University Area
The Rotary Club of Austin University Area embodies the Rotary credo of Service Above Self. We are dedicated to helping the underserved in our Austin community who need it the most. We support our community through local and international service projects in education, health and human services for K-12 and the elderly. We also value lifelong education, networking and fellowship. If you'd like to make a difference in our community, please join us. We meet every Monday from 6:15 PM to 7:30 PM.
Name

First NameLast Name
Preferred Name or Nickname
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Marital Status

Other
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.Format: (000) 000-0000.
Type of preferred number
Optional - Other Phone Number (Home, Business, etc.)
Please enter a valid phone number.Format: (000) 000-0000.
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?

Other
Member Sponsor

First NameLast Name
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
Signature
Date of Application

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: