Rotary Club of Charlotte Membership Application Test 5

Rotary Club of Charlotte Membership Application Test 5

Potential members are asked to complete the following information.   Starred items(*) are required.
After completing this form, click 'Submit' and the Club you are requesting to join will receive your application. 

Please Choose Type from the following: settings - Choose - Individual Corporate Non-Profit

Title settings - Choose - Dr. Mr. Miss Ms. Mrs. Other

First Name * settings

Middle Initial settings

Last Name * settings

Suffix settings - Choose - Jr. Sr. II III Other

Nickname/Badge Name settings

Birthdate * settings

Gender * settings - Choose - Female Male Prefer not to say

Email * settings

Home Phone settings

Cell Phone settings

Home Address Street settings

Home Address Street settings

Home Address City settings

Home Address State settings

Home Address Zip settings

County settings

Business/Employer Name

Business Position/Job Title settings

Business/Employer Website settings

Business /Employer Phone settings

Business/Employer Address Street settings

Business/Employer Address Street settings

Business/Employer Address City settings

Business/Employer Address State settings

Business/Employer Address Zip settings

Business/Employer County settings

Preferred Mailing Address settings - Choose - Home Business/Employer

Sponsor 1 settings

Endorser 1 settings

Endorser 2 settings

Spouse/Partner First Name settings

Spouse/Partner Middle Initial settings

Spouse/Partner Last Name settings

Spouse/Partner Suffix settings - Choose - Jr. Sr. II III Other

Spouse/Partner Nickname settings

Spouse/Partner Date of Birth settings

Married? settings - Choose - Yes No

Anniversary Date settings

Is Spouse/Partner a Rotarian settings - Choose - Yes No

If yes, Spouse/Partner Rotarian # settings

Applicant Previous Rotary Club #/Club Name/City/State settings

Applicant Previous Rotary Date Joined settings

Applicant Previous Rotary Date Resigned settings

Applicant Previous Rotary Email settings

Applicant Previous Rotary (if needed) Club #/Club Name/City/State settings

Applicant Previous Rotary (if needed) Date Joined settings

Applicant Previous Rotary (if needed) Date Resigned settings

Applicant Previous Rotary (if needed) Email settings

Club Participation & Achievements (ie: offices held in club and which year)

Please provide a brief statement about your interests, hobbies, and any community service or volunteer work you have been involved in.

Bio & Description settings

Education & Degrees settings

Hobbies & Interests (ie: golfing, fishing, hunting, etc.) settings

E-Signature * settings

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Clear

Submit

Rotary Club of Charlotte Membership Application Test 5

Click Submit to finish.

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