Rotary Club of West Liberty

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Membership Application

Rotary Club of West Liberty Application for Membership

This is an application to be considered as a new member of the Rotary Club of West Liberty.  The Board meets the second Tuesday of the month and votes on all proposed new members. Your application is due to the Membership Chair by noon on the first Tuesday of the month to be considered for membership at the following Board meeting. Email the completed application to: rotaryclubwestliberty@gmail.com

Date:

Your First and Last Name *

Your Preferred Name (if different from your name)

Email Address *

Primary Phone Number *

Home Address *

Street Address

City                                          State/ZipCode

Date of Birth (MM/DD/YYYY) *        

First and Last Name of current member proposing you*

Check here if you are a self-referral ______

How did you hear about Rotary and why are you seeking to join our club?

Any additional comments you wish the Board to know about your interest in the club.

Signature:                                                       Date:

Printed Name:

 

Email the completed application torotaryclubwestliberty@gmail.com

Click to see more about the West Liberty club's involvement in eradicating polio worldwide.
Learn more about West Liberty's involvement in eradicating polio

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  • About
    • Who We Are
    • About Rotary
    • Rotary Foundation
    • Join Us
    • Contact
  • News
  • Projects
    • Current Projects
    • Fight Against Human Trafficking
    • Past Projects
  • Fundraisers

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