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SEATTLE INTERNATIONAL ROTARY CLUB APPLICATION
NAME:
Nickname:
Occupation:
Employer:
Birth Mo. & Day
Suggested Classification:
Spouse/Partner Name and Occupation:
Home Address
Work Address
Address Line 1:
Address Line 1:
Address Line 2 (Optional):

Address Line 2 (Optional):
City, ST ZIP:
City, ST ZIP:
Home Email:
Work Email:
Phones
include area code:
Home:
Work
Cell:
Fax
Preferred Contact Point:
Phone: Home or Work
Mail: Home or Work
Your Special Interests and Talents:
Community Involvement (Past and Present):
Does occupation/employer support regular Rotary attendance and financial participation?
Why do you want to be a Rotarian?

Committee Interests:
We would like every member to participate in one or more committees. Please check those areas that would be of interest to you. Add comments if you like.
Community Service

Membership

Giraffe Project
Recruiting
Bailey Gatzert School (other)
Mentoring
Junior Achievement
Vocational Service

Rotary First Harvest
Scholarships

Homeless Youth
Ambassadorial Scholarships
Other (ideas welcome)


Club Service

Other (ideas welcome)
Program
International Service
Social Events
Microlending
Fundraising

Water
Public Relations

China Schools
Newsletter

China PKU Factory
Website

Group Study Exchange
District Liaison
Other (ideas welcome)


Other





Foundation




Applicant Certification:


I understand that it will be my duty, if elected, to exemplify the Object of Rotary in my daily contacts and activities, and to abide by the constitution and by-laws of the club. I understand that part of my membership dues will provide me with an annual subscription to the official magazine or an approved and prescribed regional magazine as may be applicable. I agree to pay the admission fee of $50 and the annual dues of $200 in accordance with the by-laws of the club. I hereby give permission to the club to publish my name and proposed classification to its members.
Applicant Certification (continued):

I also confirm my commitment to meet Rotary's attendance requirements of at least 60% of weekly luncheon meetings calculated on a monthly basis. I also agree to contribute or raise $500 per current club year or whatever club goal is set for current year for the Rotary club's charitable contributions. Further, I accept my responsibility to be an active club member by serving on club committee(s). I also understand the opportunities to make financial contributions to Rotary International Foundation (TRF).

Signature: ___________________________ Date: _____________________

Sponsor: _________________________



RECORD OF ACTION ON PROPOSAL:

Proposal received by Secretary/Membership

Submitted to Board

Proposer notified/Application Delivered

Application Returned

Profile Published in Newsletter

Applicant Announced at Two Meetings

Welcome Letter/Invoice

Applicant paid Dues

Badge Ordered

Applicant Inducted



Secretary's Signature: __________________________________
 
 
Sponsors