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 *
Name
Nickname
Nickname
Birthdate *
Birthdate
Gender *
Home Phone
Home Phone
Cell Phone *
Cell Phone
Sponsor Name *
Sponsor Name
Home Address
Home Address
Business Address
Business Address
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Spouse/Partner Name
Spouse/Partner Name
Married
Rotary ID Number, Club #, City, State, Date Joined, Date Resigned
Personal Section
Community organizations you are involved with (board, member, volunteer, etc.) projects, organizations, subjects you could give a 10 minutes talk to the club.