Membership Application — Rotary Club of Chestnut Hill

Rotary Club of Chestnut Hill Membership Application

To become a member of our Rotary Club, please follow these 3 steps:

STEP 1: Complete the application below.
Our Membership Committee Chair will contact you to discuss membership requirements including financial, attendance and involvement and to share your interest in joining Rotary.

STEP 2: Attend one of our breakfast meetings.
Upon approval by the Membership Committee, your application will be referred to the Board of Directors for final approval.

STEP 3: Once approved, pay your membership dues.
The club Treasurer will contact you about how to pay your dues.

Date of Application

MM

DD

YYYY

Name of applicant

First Name

Last Name

Occupation

Please list your position / title. If retired, list previous primary occupation.

Company name (if applicable)

Principal type of business (if applicable)

Company address (if applicable)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Work Phone (if applicable)

(###)

###

####

Email

Home Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birthdate

MM

DD

YYYY

Affiliations

Please list any civic organizations in which you are currently active, any military service or current veterans’ activities, or any other community involvement.

How did you hear about the Rotary Club of Chestnut Hill?

Reasons for wanting to join Rotary

Have you ever been a Rotarian?

Yes

No

Are you transferring your membership? (if applicable)

Yes

No

Previous Rotary experience (if applicable)

List last club name, and indicate if you have ever served as Club President (with year)

Applicant Signature

Please type in your full name, which serves as your digital signature and certifies that all information contained in this application is true and accurate. I fully understand the privileges and responsibilities of membership in the Rotary Club of Chestnut Hill. I agree to give one month's written notice if I decide to terminate my membership.

The Rotary Club of Chestnut Hill does not discriminate on the basis of race, color, gender, age, religion, national origin, or disability in membership practices, programs or activities. This policy is in accordance with the state and federal laws, Section 504 of the Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990.

Rotary Club of Chestnut Hill Membership Application

Everyone is welcome to join our meetings