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Rotary Club of Greensboro Membership Application

Membership Application
Applicant Name*
First Middle Last
Preferred Name/Nickname*
Who is the Rotary Club Member proposing you for membership?*
First Last
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.
Community Service Projects
- Project Rebuild - Access ramps for low-income
- Salvation Army Kettle Bell Ringing
- Rotary Youth Leadership Camp
- PigStock - BBQ competition to support charity
- Tutoring at Sumner Elementary School
- Food Insecurity Projects
International Service
- Rotary Foundation
- World Community Service
- Youth Exchange
- End Polio Now
- Global Grants and Scholars
Club Service
- Fellowship/Greeters
- Registration Table
- Fundraising
- Public Image - Social Media
- Sergeant-at-Arms - Club meeting setup
- Membership Recruitment
- New Member Orientation
- Membership Engagement
- Social and Networking Events Planning
- Service Project Coordination
- Donations Committee - Grant Appliications Review
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

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