Membership Application for the Rotary Club of Southwest Orlando

MEMBERSHIP APPLICATION FOR THE ROTARY CLUB OF BOISESOUTHWEST

I, the undersigned, being familiar with the requirements for and conditions of membership hereby make application for Membership in the Rotary Club of Boise Southwest.

I am personally actively engaged in the business, profession or professional activity covered by the classification listed on the next page, or retired from this classification, and have my place of business or residence located within the territorial limits of the Rotary Club of Boise Southwest or within the territorial limits of an immediately adjoining club.

I understand that it will be my duty, if elected, to exemplify the Object of Rotary and the Four-Way Test in all my daily contacts and activities, and, at all times, to abide by the constitution and by-laws of the club. I understand that part of my membership dues will provide me an annual subscription to the official rotary magazine.

I agree to pay the admission fee of $100.00 prior to being admitted to the club,the dues of $50.00 per quarter,and meal charges of $174.00 per quarter payable in advance($224.00 per quarterprorated for the first quarter). Additionally, I wish to donate $___ (quarterly or one time) to the Rotary Foundation in support of international goals. Further I understand that 50% attendance is required each half of the year (30% attendance at our club meetings) either at the Rotary Club of Boise Southwest, or any of the tens of thousands of Rotary Clubs around the world or other make up opportunities. Not maintaining attendance and keeping my account current are both grounds for termination of my membership.

I hereby give my permission to the club to publish my name and proposed classification to its members.

Date ______

Signature ______

Sponsor ______

NAME: First ______Last ______

Middle ______Nickname ______

Spouse/Partner Name ______

Preferred Mailing/Billing Address: Home __ Work __

Residence Address ______

City ______Zip ______

Residence Phone ______Classification ______

Title ______Name of Firm ______

Business Address ______

City ______Zip ______

Business Phone ______Fax Number ______

Email addresses (H)______(W)______

Preferred email Address: Home __ Work __

Cell Phone Number ______Your Birthday___/____/_____

Children______

Hobbies______

Will you provide a digital jpeg headshot for the directory Yes ___ No ___ Please. Provide a two paragraph bio for the website, see for examples

Former Rotarian Yes ____ No ____ If Yes, Club ______

District number ______Rotary ID Number ______

Date Joined Former Club ______Rotary Offices Held ______

Paul Harris Fellow Yes ___ No ___ Sustaining Member Yes ___ No ___

Benefactor Yes ___ No ____ Date Joined ______