Proposed New Member Form

The form is completed by the proposed new member's sponsor prior to board review.

Sponsor *
Proposed New Member Name *
Proposed New Member Name
Date of birth *
Date of birth
Address *
Phone - Home *
Phone - Home
Phone - Work
Phone - Work
Phone - Mobile
Phone - Mobile
What is your business/profession?
If rejoining or a former Rotarian, list most recent club information including previous club name, dates, membership ID
Please provide a short personal Bio
Names of spouse and children with birthday month & date only (no years)
Optional - giving through you dues invoice
Indicate If you would like to give to RI and/or our club Styres Scholarship fund through regular quarterly club dues invoicing