NEW MEMBER PROPOSAL FORM
Name of Proposed New Member
Business: Street Address
Business Address: City and Zipcode
Business Telephone
Business Fax
Business eMail Address
Residence: Street Address
Residence: City and Zipcode
Residence Telephone
Residence Fax
Residence eMail Address
Active or Honorary Member?
If former Rotarian, which club?
If former Rotarian, please provide dates
Proposed Classification (if active)
Name of firm and executive position
Former firm / position, if retired
Activities enhancing consideration
Name of Sponsoring Member