Membership Nomination Form

Nomination Form

Name:

Are you a current or former Rotary member?

New Member
Transferring or Former Member

Previous Rotary Membership ID:

Date of Birth:

Business Address:

Business Telephone:

Email Address:

Residence Address:

Residence Telephone:

Cell Phone:

Profession:

Language Skills:

Name of Business/Employer and Position (or former name, if retired):

Prior Community Involvement Experience:

Spouse's Name:

Spouse's Date of Birth:

Sponsor's Name:

Submit

Rotaract

Do you want to be part of a global community of young adults taking action for positive change? Are you looking for the chance to share your ideas and look at the world’s challenges in a new way? Join the Hammond Rotaract club and find all this and more!

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