EmailMe Form - Rotary E-One Satellite Club Membership

Full Name *

First Last

Birthdate

MM / DD / YYYY

Membership for this club is for the age of 18 to 45.

Former or current firm of employment: Enter NA if not employed *

Professional Position Held: Enter NA if not employed *

I am a student *

Yes

No

My Rotary Status *

Host Country *

Sponsor Country *

Tell us about your Rotary experience

Contact Information

Please include country and area code in phone numbers

Telephone *

Email Address *

Mailing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Other information you would like to share?

How did you hear about the Rotary E-Satellite Club? *

Activities that would enhance consideration as a Rotary E-Satellite Club Member *

Are you prepared to take on a leadership Position in this club? *

Yes

No

Maybe Later

Other

What is your preferred Method of Communication? *

Email

FB Messaging (please ensure you have provided your FB link in the Other box below)

Other

Membership Qualifications Requirements

Prior to being considered for Rotary E-Satellite Membership, the applicant must have attended one web-site meeting at the Rotary E-club of Canada, and one On-line Fellowship event, posted in the Events link on the website at www.rotaryeclubcanada.ca and must have completed and submitted the attendance form on our website. Once accepted, the member must agree to attend a minimum of one Club Meeting per month and commit to a minimum number of Service Hours as decided on by the Club Team.

This application must be accompanied by a $25.00 Admission Fee which can be paid via PayPal here: https://www.paypal.com/donate?hosted_button_id=3R5KBZRSXLYFU&source=url

We require that a photograph be submitted as part of the application *

By submitting this application I have agreed to all requirements and conditions. *

I Agree