ROTARY CLUB OF CAPE HENRY

ROTARY MEMBERSHIP APPLICATION

Potential members are asked to complete the following information (*) are required. After completing this form, click ‘Submit” and the Club will receive your information and intent.

Name

First Name

Last Name

Nickname

First Name

Last Name

Birthdate

YYYY

Gender

Male

Female

Other

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Sponsor Name

First Name

Last Name

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Business Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Website

http://

Spouse/Partner Name

First Name

Last Name

Date of Birth:

Married

Yes

Previous Rotary Clubs

Rotary ID Number, Club #, City, State, Date Joined, Date Resigned

Personal Section

Club Participation/Achievements i.e., offices held in club and which year

BIO/Description i.e., personal and professional

Degrees

Hobbies/Interests

Community Leadership plus other comments

Community organizations you are involved with (board, member, volunteer, etc.) projects, organizations, subjects you could give a 10 minutes talk to the club.

To verify receipt of Membership Application, please email Lori@LoriByDesign.net

Cape Henry Rotary Club
Service above Self with Action + Fun!

We meet every Wednesday morning from 7:30 - 8:30 AM at:

Craft Burger Bar, 2947 Shore Drive, Virginia Beach, VA 23451

We would like to invite you to join us. Our meetings are always fun, informational, very social—
and a great way to start your day!

CONTACT FOR President: Cindy Stover, cinzia@baytaxllc.com
CONTACT FOR Treasurer: Charles Arrants, csaosg@gmail.com
CONTACT FOR Membership: Dave Zobel, dmzobel1958@gmail.com
CONTACT FOR Charities: Kathy Jeffries, krjphotog@yahoo.com
CONTACT FOR Events: Ellen Duckworth, duck5373@yahoo.com

Mailing address:

Rotary Club of Cape Henry | P. O Box 5743 | Virginia Beach, VA 23471-0743

ROTARY CLUB OF CAPE HENRY

ROTARY MEMBERSHIP APPLICATION

Cape Henry Rotary ClubService above Self with Action + Fun!

We meet every Wednesday morning from 7:30 - 8:30 AM at:

Craft Burger Bar, 2947 Shore Drive, Virginia Beach, VA 23451

We would like to invite you to join us. Our meetings are always fun, informational, very social—and a great way to start your day!

Cape Henry Rotary Club
Service above Self with Action + Fun!

We would like to invite you to join us. Our meetings are always fun, informational, very social—
and a great way to start your day!