Rotary Club of Oriental Membership Application
Candidate Name_______________________________________________________________
Mailing address_______________________________________________________________
Telephone home________________business__________________cell___________________
E-mail Address________________________________________________________________
Date of Birth ________________________ Partner’s Name ___________________________
Skills, interests, or capabilities that might serve our club and community__________________
____________________________________________________________________________
Occupation/profession, employer, and location ______________________________________
____________________________________________________________________________
If former Rotarian, lists club, dates and RI membership number_________________________
____________________________________________________________________________
I hereby certify that I am qualified for membership by having a place of business or residence within the club’s territorial limits.
If inducted, I will exemplify the objectives of Rotary in my daily contacts and activities and abide by the by-laws of the club. I agree to pay an admission fee of $ 25.00 upon acceptance and monthly dues on a timely basis.
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Copy this page and paste in an email to Membership Chairman: jmitchell44@gmail.com
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To be completed by Membership Chairman
Sponsor(s)_____________________________________________________________________
Interview ________________Attendees_____________________________________________
Board approval ___________ Mentor _______________________________________________
Date Inducted ____________