Rotary Membership Application

Park City Rotary

Membership Application Form
Thank you for your interest in Park City Rotary! We are part of an international service organization of 1.2 million business leaders and professionals united worldwide to serve our communities and work toward understanding and peace.

Park City Rotary meets weekly to enjoy lunch, learn about the greater community and plan ways to serve.

After you complete this application it will be submitted to our club for approval. Turnaround time may take a few weeks, but in the meanwhile please continue to join us for lunch meetings! If you have any questions, please contact us.
Personal Information
Name

First NameLast Name
Nickname or Preferred Name
Sponsor's Name
E-mail
Mobile Phone Number

Area CodePhone Number
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
HomeWork
Date of Birth

MonthDayYear
Date
MaleFemaleNonbinary/NonconformingPrefer not to respondOther
Spouse/Partner Name
Anniversary

MonthDayYear
Date

Tell us about yourself!
We'd love to learn more about you...
Are you a past Rotarian?
Please indicate club name and location.
If yes, what's your past Rotary experience?
Offices held, committee experience, etc.
Occupation or Classification (Career Field)
Education/Degrees or Certifications
Hobbies/Interests
Involvement in Community Service?
EnglishSpanishFrenchOther
Community ServiceSocial/Community InvolvementProfessional Development/NetworkingInternational Service ProjectsOther
Any comments or other information you would like us to know?

Membership Fees & Requirements
Membership Fees

Individual membership with Park City Rotary has an annual minimum cost of $1630, billed in a monthly invoice of approximately $127.50/month. This includes tax-deductible contributions and lunch at our standard location (and occasional offsite locations) for 50 weeks every year.

The monthly invoice consists of:
- $9 Donation to the Park City Rotary Foundation
- $9 Donation to The Rotary Foundation (Rotary International)
- $15 Dues to Park City Rotary Club
- $94.50 Lunch Fees
Additional Fees
- Members are also charged $100 (included in the $1,630 total mentioned above) every September to purchase balls in the club's signature fundraising event, the Running of the Balls on Miners Day. (Members may resell their balls to family & friends if they prefer not to participate.)
- Members may occasionally be charged small "Fines" (generally less than $3) as part of the weekly "Sergeant at Arms" presentation, which is an irreverent look at our Park City community and our members' participation.
- Members may bring guests to lunch meetings, and will be charged $20/guest.
We do offer a "Membership Assistance Program" to help members that need financial assistance.

Note: All members must participate in the "Auto Pay" program (unless alternate arrangements are made) to ensure monthly payment of dues. New members must enroll in Auto Pay and supply a payment method (credit/debit card or bank account) upon acceptance to the Club.

Prospective members are encouraged to attend lunches during the application process, free of charge.
Regular Individual MembershipIndividual Membership with Membership Assistance Program
Attendance Requirement

Our club is most vibrant when its members are active. To achieve this, we expect members to attend at least 60% of lunch meetings, or to "make up" missed meetings by participating in service projects, social events, or visiting other Rotary club meetings.
I have read and understand the membership fees and attendance requirements.I understand that, if accepted, I must enroll in the Auto Pay program or make alternate arrangements for payment.
Application Date

MonthDayYear
Date
Signature
Thank you for applying for membership to Park City Rotary!
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Park City Rotary

Personal Information

Tell us about yourself!

Membership Fees & Requirements

Thank you for applying for membership to Park City Rotary!