EmailMe Form - Fonthill Rotary Membership Application

Full Name *
First Last
Business/Profession
Email Address *
Telephone
### - ### - ####
Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Date of Birth
MM / DD / YYYY
Spouse's Name
First Last
Previous Rotary Membership Club
Previous Rotary Membership RI#
You will be expected to participate in the activities of at least one of the Five Avenues of Service. Please check at least one of interest to you.
Volunteer Position
Club Service
Vocational Service
Community Service
International Service
Youth Service
Sponsor Name
First Last
I understand that it will be my duty, if elected, to exemplify the object of Rotary (see reverse) in all my daily contacts and activities, and, at all times, to abide by the Constitution and By-laws of the Rotary Club.

I agree to pay the annual fee in accordance with the By-laws of the Club. I hereby give permission to the Club to publish to its members my name and proposed classification (for active members).
Signature
Clear