Rotary Club of Healdsburg Sunrise

PO Box 302

Healdsburg, CA 95448

APPLICATION FOR MEMBERSHIP

NAME Nickname

Occupation Employer

Suggested Classification

Home Address

Home email

Work Address

Work email

Home phone Cell phone

Work phone Fax

Date of Birth Anniversary Date

Partner’s Name Date of Birth

Have you previously been a member of Rotary? Your Rotary ID #

If yes, which club/how long?

Do you prefer to be contacted at your home or work email address?

Your Special Interests, Hobbies 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?

Rotary Club of Healdsburg Sunrise has many avenues for Rotarian involvement. All members are expected to participate actively on a committee. Please indicate your area(s) of interest.

Club Service
Sample activities: Coordination of fellowship and social events for members, communications to members via email, newsletters and website, speakers and programs for weekly meetings.

Community Service

Sample activities: Foss Creek Clean-up, Spearheading the Annual Fund Raiser, the Wonder League and The High School Scholar Athlete Awards.

International Service

Sample activities: Clean Water Project, education and health in impoverished regions, working towards the global eradication of Polio and participation in the Group Study Exchange.

Vocational Service

Sample activities: Teacher Recognition Breakfast, Marcie Beccera Academy Mentoring Program, CHOICES Workshop (2 Day Workshop for all Healdsburg High School 9th Grade Students).

Rotary Foundation

Sample Activities: Annual programs fund Every Rotarian Every Year and the Paul Harris Fellow Program.

Membership(under Club Service)

Sample activities: New member recruitment, orientation programs, and mentoring program for new members.

New Generations Service

Sample Activities: Programs that foster the involvement of youth in community such as Interact,

Rotary Youth Leadership Awards, Rotary Youth Exchange, and Rotaract.

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 Rotarian magazine or an approved and

prescribed regional magazine as may be applicable.

I agree to pay the admission fee of $65.00 which includes the Jester Hat, and

the annual dues of $140.00 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.

I confirm my commitment to meet Rotary's attendance requirement of at

least 50% of weekly meetings each month, after 90 days of 90%

attendance.

I agree to help raise money towards whatever club goal is set for the

current year for our Rotary Club's charitable contributions.

I accept my responsibility to be an active Club member by serving on

Club committees.

I understand the opportunities to make financial contributions to the

Rotary International Foundation.

Signature Date

Sponsor’s signature

Membership Proposal Form

Part A (to be completed by sponsor and returned to the club secretary)

I propose:

Full Name:

Mailing Address:

Telephone: Residence Cell

Business FAX

Preferred email address:

Proposed Classification:

If rejoining or a former Rotarian, list most recent club information:

Club Name:

From Until RI ID #

If an RI program participant or Foundation alumnus/a, list program(s) & dates:

Activities that would enhance consideration as a Rotarian:

Sponsor’s Signature Date

Part B (to be completed by proposed member after Board approval)

I hereby certify that I am qualified for active membership by my current or former status as a business, professional, or community leader, or as a Rotary Foundation alumnus/a, and by having a place of business or residence within the club’s locality or surrounding area.

I understand that, if accepted for membership, it will be my duty to exemplify the Object of Rotary in all my daily contacts and activities and to abide by the constitutional documents of Rotary International and the club. I agree to pay any admission fees required by the club and to pay annual dues in accordance with the club by-laws. I hereby give permission to the club to publish my name and classification, if applicable, to its membership.

Proposed Member’s Signature Date

To be completed by Membership Chair

Applicant’s Classification

If applicant is a former Rotarian fill out the following:

Name of club

District # Club ID # Rotary ID #

Dates of Membership from to

Rotary Experience or Distinction, Paul Harris or other

Former Rotary contacted and good standing confirmed on

Mentor assigned to assist with orientation

Action On Proposal to be completed by Secretary

Membership Committee approved on not approved

Application received by Secretary on

Application proposed to the Board on Board Approved on

Application proposed to the club on Club Approved on

Rotary Information Session held on with

Signed form and admission fee received

Club Runner Login Name

Temp. Password

Admitted to Membership on