Rotary Club of Mineral Wells Member Application Form

Member Application Form

Thank you for your interest in joining the Rotary Club of Mineral Wells. Please complete the form below to apply for membership in our Rotary club. Annual Membership Fee $250, Foundation $100. *This membership covers for one Rotary year 7/1 through 6/30. Membership and Sponsorship checks should be written out to Rotary Club of Mineral Wells and mailed to P.O. Box 1151, Mineral Wells, TX 76068. For more information about Rotary and starting your journey as a Rotarian, visit our website at www.mineralwellsrotary.org.
Who is your Rotarian sponsor or reference?
Full Name

First NameLast Name
Nickname:
Gender
Home E-mail
example@example.com
Work E-mail
example@example.com
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.
Mobile Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Name of Business
Work Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Send Rotary Correspondences to:
Birth Date (MM/DD/YYYY):
Anniversary (MM/DD/YYY):
Spouse/Partner First and Last Name:
Spouse/Partner Birth Date (MM/DD/YYYY):
Spouse/Partner Phone Number:
Tell us what is your motivation to join our Rotary Club? Include skills you possess that would be beneficial to the Club and list committees you are interested to join.
Describe your past involvement with the community and service?
Were you a past member of a Rotary Club?
If yes, name of club and location?
Were you a past participant in a Rotary International or Rotary Foundation program?
If yes, which program and when?
Are you applying for a Corporate Membership?
Are you a military veteran?
If so, which branch of service? Include years of service start and end (MM/YYYY).
Educational Degree (i.e. High school diploma, Bachelor's, Master's, PhD etc.):
List any certifications you possess:
List the name of college/university attended? Include years started and graduated.
Membership Approval Process

To understand the rights, privileges and responsibilities of membership and the operation of our club, be sure to review our Membership Process on www.mineralwellsrotary.org. Once you submit your application, we will contact you shortly to complete your membership application. Any questions, send an email to mwrotaryclub@gmail.com.
Please confirm you understand the privileges and responsibilities associated with your Rotary membership and agree to promote the ideals of Rotary and comply with the requirements of the Rotary Club.
Should be Empty:

Member Application Form

Membership Approval Process