Kiwanis Club of Ottawa - Form to Propose a New Member

KIWANIS CLUB OF OTTAWA –Membership Application Form

“One Can Make A Difference:

(NOTE: 2sponsors are required, with a combined minimum of three years service in the Club)

We are pleased to recommend the person named below as a prospective member of the Kiwanis Club of Ottawa. We have made them aware of the various commitments and obligations that are listed on the reverse side of this form, and they have expressed a sincere interest in helping to further the Club’s community service objectives.

(PLEASE PRINT)

FULL NAME of Prospect:UTTRA BHARGAVA

Preferred First Name UTTRA How Long Have you Known the Prospect?11 YEARS

Name of Spouse (or equivalent): SAM (CURRENT MEMBER & SPOUSE)

COMPANY Name___N/A______

Position or Title _____N/A______Type of Business: ______

COMPANY Address______City/Prov______

Postal Code______Telephone No______Ext.______Fax No______

Website: ______Email______

HOME Address: 304 RYWALK CIRCLE, City/ProvOTTAWA, ON

Postal CodeK1T 0C7Telephone No. 613-748-3316 Fax No.______

Please describe the prospect’s previous Service Club and/or Community Volunteeractivities. In particular, this section should specify the roles the prospect played in these activities, and the length of time they were involved in each volunteer role:

PAST PRESIDENT AND MEMBER OF KIWANIS CLUB OF BYTOWN

Please mention other Business or Professional Organizations in which the prospect was or is involved, and provide details of the type and length of involvement:

______

CURRENTLY OPERATING 2 DAY CARE CENTRES, 1 IN PINEVIEW AND 1 IN ORLEANS.

(continued…)

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Describe any Other Interests, Hobbies, Special Skills and Accomplishments of the prospect which you feel would be of interest to the Membership Committee:

______

FAMILY – 4 CHILDREN AND 5 GRANDCHILDREN

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Indicate whether they have participated in our activities (Friday luncheons, social events or fundraisers) on at least 3occasions and have met several members of the Club. You recommend this person for membership in the Kiwanis Club of Ottawa for the following reasons:

UTTRA IS A FREQUENT GUEST & WIFE OF MEMBER SAM BHARGAVA AT KIWANIS LUNCHEONS.

______

______

We have discussed the Club’s structure with the prospect and, based on their interests, we recommend them for the following committee:

__X_1 FUNDRAISING COMMITTEE & 1 COMMUNITY SERVICES COMMITEE.

Experience has shown that new members are uncomfortable if they are not made aware

of certain requirements and procedures of the Club. For this reason,

ITIS ESSENTIAL THAT THE SPONSOR DISCUSS THE FOLLOWING TOPICS IN DETAIL WITH A

POTENTIAL MEMBER BEFORE THIS FORM IS SUBMITTED
Discussed?

A/ Attendance - A member is encouraged to maintain at least 70% attendance.

Explain how attendance credits can be obtained outside of our Friday luncheons. Y/N ( Y )

Also explain the Leave of Absence for circumstances requiring a temporary absence.

B/ Club Structure and Committees - Our Club’s lifeblood is the committee work. Y/N ( Y )

A new membermustbecome an active participant on at least one committee.

C/ Financial - Excludingthe $250 one-time initiation fee, the total annual cost of membership

isapproximately $1,100, which includes Annual Membership Dues of $355, and semi-monthlyY/N ( Y )

Luncheons of $806 ($31 per week x 26 ) which can be prepaid quarterly, as well as

small incidentalssuch as raffle prizes and fines. Luncheon payment options are available.
D/ Police Record Check–is required for ALL new members (effective January 17, 2008) Y/N ( Y )

and must be current (within 2 years). Since you are seeking membership to ‘primarily serve the

vulnerable sector of the population’ there should not be any charge.

SPONSORS:

Print Names: Sponsor #1 PHIL ROSSY-PRESIDENTSponsor #2 ROSS CHRISTENSEN

Signature:X_______Signature: X_______

For office use only ( 4-6 weeks procedure)

1. PROPOSAL HANDED IN: Date:______/20______

2. RECOMMENDED TO THE BOARD BY MEMBERSHIP COMMITTEE:______/20______

3. APPROVED BY THE BOARD OF DIRECTORS:______/20______

4. Bulletined on our Club website for 10 days, to ensure No Objections______/ 20_____

4. SPONSORS ADVISED(when date with no objections has passed):______/20______

5. NEW MEMBER INTRODUCED TO THE CLUB:______/20______

PRIVACY POLICY TheKiwanis Club of Ottawa is committed to protecting and safeguarding the personal information that is given to us. We do not trade our membership lists, but rather use them to keep members informed about Kiwanis Club of Ottawa activities and services. Please contact the office if you want your name removed from our mailing list. Revised September 2011