ROTARY CLUB OF SPRINGFIELD
MEMBERSHIP PROPOSAL AND APPLICATION
To:
Membership Committee and Board of Directors
TO BE COMPLETED BY SPONSOR PROPOSING CANDIDATE FOR MEMBERSHIP
I hereby propose the following candidate for membership in the Rotary Club of Springfield. In making this
proposal I have considered the criteria for membership eligibility.
Name of candidate:
Work phone:
__________ Cell:
__________Home:_________________
Email address:
Employer:
Position:
Length of time in position:
Length of time in Springfield:
Home address:
Business address:
Place of birth:
Date of birth:
Spouse/partner name:
Children:
Prior Rotary membership:
Participation in Rotary programs (GSE, Youth Exchange, Ambassadorial Scholar, Peace Scholar):
Please state this applicant’s qualifications for membership in the Rotary Club of Springfield, and why you
believe this applicant will enhance the membership of this club, which has long been a club of men and women
who give leadership in the community and which continues to seek new members to follow in that tradition
(please use additional sheets, if necessary):
I understand that this proposal is to be kept confidential until the Board has acted upon it.
Signed:
Date:
Eligibility for membership in the Rotary Club of Springfield
as defined by the By-Laws of the Club
This club shall be composed of adult persons of good character and good reputation,
having a high degree of management function or professional designation in their career
fields and who are making a difference through leadership in business, the professions,
and/or the civic community. Generally, proposed members should have three years or
more experience in their career fields to have established their reputation and character.
Individuals with less time in their fields may be considered for membership if they have
demonstrated extraordinary potential for such leadership. Persons who have retired but
who have met the above general qualifications during their active professional years
shall be considered eligible for membership.
For clarification of club policy regarding membership eligibility, contact the Membership Committee Chair or
the club President. Please return the completed application to
The Rotary Club of Springfield
E-mail: kim@clubmanagementservices.com
1717 E. Republic Rd., Ste. A
Fax: 417-886-3685
Springfield, MO 65804
TO BE COMPLETED BY APPLICANT FOR MEMBERSHIP
Please state why you are interested in membership in the Rotary Club of Springfield:
Please provide your educational and professional background (a brief resume may be provided in lieu of setting
forth here). Please include positions held and a brief description of responsibilities:
Please provide a description of your involvement in the community, including membership in civic or
professional organizations (may be included in resume in lieu of setting forth here):
Are you currently charged with or under indictment for, or have you ever been convicted of or plead guilty to a
felony?
Yes
No
If yes, please explain:
I hereby affirm that the statements contained herein or on any attachments are true to the best of my knowledge
and belief. I understand that this application for membership will be held in confidence until the Board has
acted upon it and the club executive secretary informs my sponsor of the action taken.
Signed:
Date: