EmailMeForm
New Member Pre-induction Questionaire
The information below is used to create your member profile, and to help us get to know you a bit. Please fill in as much information as possible.
This form should be sent to the new member for them to fill it in.
Name
*
First
Last
Birthday
*
MM
/
DD
/
YYYY
Wedding
Anniversary
MM
/
DD
/
YYYY
Spouse/Partner Name
Spouse/Partner Birthday
MM
/
DD
/
YYYY
Home Phone
Cell Phone
Office Phone
Office fax
Rotarian Magazine
delivery preference
*
US Postal Service (paper)
Internet (Zinio)
The Rotarian magazine comes with membership automatically. You can receive either a paper version, or digital. The digital version is delivered via the Zinio service.
Information for getting started
These questions are to help us introduce you to the club and get you started in Rotary.
Areas of interest (Hobbies, sports, music, reading, etc.)
*
Brief bio for introducing you to the club. Also enter any other information you'd like the club to know about you.
*
Why are you joining Rotary (for the intro)?
Profile picture:
Please upload a picture for your profile. These are only viewable by members.
*
Inventory of interests
Would you like your family involved in Club activities?
Yes
No
List skills you would like to use:
Please check topics that interest you:
Community Service
Children/Youth
Disabled persons
Health Care
Literacy and numeracy
Population issues
Poverty and hunger
Urban concerns
Seniors
Other
Club Administration
Club newsletter
Club programs
Fellowship
Fundraising
Web site and social media
Public Relations
Membership
The Rotary Foundation
Other
International Service
Humanitarian Service
Other
Vocational Service
Humanitarian Service
Other
Youth Programs
Interact (High School)
RYLA
Rotoract
Other
Any other areas of interest?
Rotary information
Previous Rotary Members only
Rotary member number
Rotary Designations
&
Foundation Recognition
Rotary Offices Held
