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 ____________