E-Club of Rotary District 7545 Membership Application

Please fill out this form as completely as possible. Submission of this application requests approval for Membership to The Rotary E-Club of District 7545 – the Mountain State Rotary E-Club. Your submission of this application authorizes us to do the following with all, an excerpt of, or a summary of, the information you submit on this application:

E-Club Membership Application

Membership Application for E-Club of Rotary District 7545

Name *

First

Last *

Last

Home Address

City

State

Zip

Country

Email *

Time Zone

Phone (primary) *

Phone (secondary)

House fax

Birthday *

Other Electronic Contact Information

Company

Title

Website

Business Phone

Business Fax

Business Address

Business City, State & Zip

Are you a previous Rotarian? If so what club and when?

Your Rotary sponsor's name, email and phone number.

What E-Club activities are you interested in?

What do you envision the E-Club doing for you?

What type of service projects interest you?

What skills / expertise do you offer E-Club activities?

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