Rotaract Club of Kalamazoo
Membership Application
Name:
Spouse Name: _______________ Date of Birth:
Home Address:
Home Phone Number: ________________________________
or
Employer:
Cell Phone Number: _________________________________
Position:
Employer’s Address:
Office Phone Number:
Preferred E-Mail Address:
To answer the following questions, double click inside the appropriate box, then under the heading “Default Value” choose “checked.”)
1.
Are you able to take part in 60% of the club’s general meetings, social activities, and service activities?
If no, please explain why?
2.
Are you willing to pay member dues of $50 per year?
3.
Are you willing to participate on a committee?
Yes
Which committee(s) would you prefer to join?
(Committee availability cannot be guaranteed)
4.
Yes
Yes
No
No
No
Community Service
International Service
Professional Development
Club Service
Finance
Membership
The Rotary Foundation offers opportunities to Rotaractors (who are not children or grandchildren of Rotarians) for study and
travel abroad. Please indicate if you are a child or grandchild of a Rotarian.
Yes, I am.
No, I am not.
5.
Applicants are asked to attend at least one meeting prior to application approval. Which meeting did you attend? _________
6.
Who were you a guest of? ______________________________________________________________________________
7. Please attach a short bio about yourself, including your professional accomplishments, as well as any personal interests.
8.
Please also attach a photo that you would like displayed in the club roster. Otherwise, your photo will be taken during your
induction ceremony.
I understand and accept the principles of Rotaract as expressed in its purpose and objectives and agree to comply with and be bound
by the “Standard Rotaract Club Constitution,” “Rotaract Statement of Policy,” and by-laws of the club. Further, I acknowledge that
dues are non-refundable.
Signature:
__________
Rotaract club secretary should retain this form for club records.
Date:
_
6/09SB