Waxahachie Rotary Club

Rotary Club of Waxahachie New Member Application - Proposal Form

Name: ______

Date of Birth: __/___/_____ Email: ______

Home Address: ______

Business Address: ______

Home Phone: ______Work Phone: ______

Cell Phone: ______Other: ______

Name/Place of Business: ______

Website for Business: ______

Occupation: ______

Spouse: ______Anniversary: ___/___/____

Sponsor’s Name: ______

If retired, name of employer & position: ______

Have you been a Rotarian and if so, which Club: ______

Activities which would enhance consideration as a Rotarian: ______

Has Rotary been explained in a manner which you totally understand by your Sponsor: Yes [ ] No [ ]

Do you understand and realize the attendance requirements for this organization: Yes [ ] No [ ]

Has the Membership Director been in contacted with you: Yes [ ] No [ ]

Date: ______Signature: ______

Date: ______Sponsor: ______

TO BE COMPLTED BY SECRETARY UPON RECEIPT:

Application Received: ______New Member Information Received: ______Board of Director Approval: ______Published: ______Inducted: ______