New Member Proposal Form
(To be completed by active member of Rotary Club of Park Cities who will be the candidate’s Proposer)
Name of Candidate
*
First Name
Last Name
Type of Membership
Individual
Dual
Corporate Small (Fewer than 10 employees)
Corporate Large (More than 10 employees
Young Professional
Mobile Phone
-
Area Code
Phone Number
Business Name
Business Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Business Phone
-
Area Code
Phone Number
Preferred eMail Address
example@example.com
Proposed Classification
If a former Rotarian, Name of Club
Dates of Membership
Qualifications
Proposed by
Proposer's eMail address
example@example.com
Date Submitted
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Should be Empty: