Capital Rotary Club - New Member Proposal

Please provide all information on the proposed new member, then click the Submit this Form button to automatically email the info to the current President-elect (Ann Elliott).
This form is for members to submit info on proposed new members. Non-members should not use this form to apply for membership.

Name of person submitting form

Email address of person submitting form

Info on the proposed member

Last name

First name

Vocational classification

Date of birth  

Age  

Sponsoring member

 

Home street address
 City
 Zip code
 

  

  
Business name
Business street address
 City
 Zip Code
 

 
Home phone  

Business phone  

Business fax  

Mobile Phone (optional)  

Preferred email

Spouse's name

Spouse's date of birth  

Anniversary  

Optional info

Proposed member's job title or position

Principal activity of proposed member's company, organization, or private profession

Secondary fax

Secondary email

Birthplace

Children

Proposed member's activities which would enhance consideration as a Rotarian

Has the proposed member ever been a Rotary Member before? Yes    No

If yes, previous club name

 


Thank you very much!