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
Mailing Address Type

HomeWork
Date of Birth

MonthDayYear
Date
Gender Identification

MaleFemaleTransgender MaleTransgender FemaleNonbinary/NonconformingPrefer not to respond
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?
Languages Spoken Fluently?

EnglishSpanishFrench
Why are you interested in joining Rotary? (check all that apply)

Community ServiceSocial/Community InvolvementProfessional Development/NetworkingInternational Service Projects
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 cost of approximately $1600, billed in a monthly invoice of approximately $120/month. This includes tax-deductible contributions and lunch at the Doubletree Hotel (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)
- $13 Dues to Park City Rotary Club
- $90.25 Lunch Fees
Members are also charged $100 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.)

We do offer a "Membership Assistance Program" to help members that need financial assistance.

Prospective members are encouraged to attend lunches during the application process, free of charge.
Indicate your membership preference:

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.
Please acknowledge your understanding of the above:*

I understand the membership fees and attendance requirements.
Application Date

MonthDayYear
Date
Signature
Thank you for applying for membership to Park City Rotary!
Should be Empty:

Park City Rotary

Personal Information

Tell us about yourself!

Membership Fees & Requirements

Thank you for applying for membership to Park City Rotary!