Rotary Club of Greensboro Membership Application

Membership Application
Who is the Rotary Club Member proposing you for membership?*
First Last
Applicant Name*
First Middle Last
Preferred Name/Nickname*
Date of Birth*
MM slash DD slash YYYY
Email*
Home Phone
Cell Phone
Business Phone
Occupation/Job Title*
Business/Organization Name*
Preferred mailing address*
- Residential
- Business
- Postal Box
Residential Address*
Street Address Address Line 2 City State ZIP Code
Business Address
Street Address Address Line 2 City State ZIP Code
Postal Box Address
Street Address Address Line 2 City State ZIP Code
Family Information
Spouse/Significant Other Name
First Last
Are you married?*
- Yes
- No
Anniversary Date
MM slash DD slash YYYY
Number of Children
Number of Grandchildren
Education
School name and degree
School name and degree
School name and degree
Military Service
Have you served in the military?*
- Yes
- No
Branch
Length of service (in years)
Rank
Previous Rotary Clubs
Have you been a member of another Rotary Club?*
- Yes
- No
Rotary ID Number
Name of Club
City
State
Date Joined
MM slash DD slash YYYY
Date Resigned
MM slash DD slash YYYY
Have you been a member of a second Rotary Club?*
- Yes
- No
Name of Additional Club
City
State
Date Joined
MM slash DD slash YYYY
Date Resigned
MM slash DD slash YYYY
Have you been a member of a third Rotary Club?*
- Yes
- No
Name of Club
City
State
Date Joined
MM slash DD slash YYYY
Date Resigned
MM slash DD slash YYYY
Community Activities
Rotary's motto is "Service Above Self." Please tell us about any community and volunteer activities you have been or are currently involved in.
Community / Volunteer Activities
Hobbies / Talents / Skills / Interests
References
Please list two other Rotary members willing to serve as references.
Name
First Last
Name
First Last
Rotary Club of Greensboro is involved in many activities and depends on its members to volunteer. In which of these might you be interested? Check as many as you wish.
Service Projects
- Project Rebuild
- Salvation Army Kettle Bell Ringing
- Kids Voting - Guilford County
Vocational Service
- Student Tutoring / Summer Elem School
- Shadow Day
International Service
- Group Study Exchange
- Rotary Foundation
- World Community Service
- Youth Exchange
- Internet Fellowships
Community Service
- Youth Activities
- Rotary Youth Leadership Program
- Interact
- Rotaract
- Carousel
- Wyndham Golf Tournament
Club Service
- Fellowship/Greeters
- Registration Table
- Fund Raising
- New Member Orientation
- Public Relations
- Sergeant-at-Arms
- Attendance
- Membership
- Membership Engagement
- Events Planning
- Habitat (new project initiated by Summit with a club in France)
- Big Sweep
- Meals of Hope
I am submitting this application for membership to the Rotary Club of Greensboro. All information is accurate to the best of my knowledge. I have read and understand the Proposed New Member Outline (Guidelines and Responsibilities) and Financial Responsibilities provided to me.
Signature*

By typing my name above, I affirm that the above information is accurate to the best of my knowledge.
Today's Date*
MM slash DD slash YYYY
Date
MM slash DD slash YYYY

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Rotary Club of Greensboro

330 South Greene Street, Suite 304, Greensboro NC 27401
336-292-4806

Rotary Club of Greensboro Membership Application

Membership Application

Family Information

Education

Military Service

Previous Rotary Clubs

Community Activities

References