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Rotary Member Application

  • Date Submitted: 12/13/2011 11:03 AM
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Part B (to be completed by proposed member after board approval)
I hereby certify that I am qualified for (check one): ❑ Active membership by both my current/former executive position and having a place of business or residence within the club’s locality or surrounding area ❑ Honorary membership by my meritorious service I understand that, if accepted for membership, it will be my duty to exemplify the Object of Rotary in all my daily contacts and activities and to abide by the constitutional documents of Rotary International and the club. I agree to pay an admission fee* of and the annual dues of in accordance with the bylaws of the club. I hereby give permission to the club to publish my name and proposed classification, if applicable, to its membership.
* Not applicable to honorary members or transferring or former members of another club

Important Reminder
Before you submit your proposal, have you…
❑ Given copies of Rotary Basics, This Is Rotary, and What’s Rotary? to the prospective member? ❑ Provided the prospective member with information about membership benefits and responsibilities? ❑ Encouraged the prospective member to tour the RI Web site, www.rotary.org?

Proposed Member’s Signature


To be completed by a club officer
Classification: If a transferring or former Rotarian, previous club information: Name: Club ID number: Dates:
From To

Action on Proposal
Received by secretary: Submitted to membership committee: Committee decision received: ❑ Approved ❑ Disapproved Submitted to board: Board decision received: ❑ Approved ❑ Disapproved


❑ Presented your club’s projects and programs to the prospective member? ❑ Completed and signed Part A of the Membership Proposal Form?

How to Propose a

New Member
Proposing new members is essential...


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