Rotary Membership Committee

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:

Title

First Name *

Middle Initial

Last Name *

Suffix

Nickname/Badge Name

Birthdate *

Gender *

Email *

Home Phone

Cell Phone

Home Address Street

Home Address City

Home Address State

Home Address Zip

County

Business/Employer Name

Business Position/Job Title

Business/Employer Website

Business /Employer Phone

Business/Employer Address Street

Business/Employer Address City

Business/Employer Address State

Business/Employer Address Zip

Business/Employer County

Preferred Mailing Address

Sponsor 1

Endorser 1

Endorser 2

Spouse/Partner First Name

Spouse/Partner Middle Initial

Spouse/Partner Last Name

Spouse/Partner Suffix

Spouse/Partner Nickname

Spouse/Partner Date of Birth

Married?

Anniversary Date

Is Spouse/Partner a Rotarian

If yes, Spouse/Partner Rotarian #

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

Applicant Previous Rotary Date Joined

Applicant Previous Rotary Date Resigned

Applicant Previous Rotary Email

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

Applicant Previous Rotary (if needed) Date Joined

Applicant Previous Rotary (if needed) Date Resigned

Applicant Previous Rotary (if needed) Email

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

Education & Degrees

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

E-Signature *

Your Cart

Rotary Club of Charlotte Membership Application Test 5

Business/Employer Name

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

Rotary Club of Charlotte Membership Application Test 5

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