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Section 1 of 2
Rotary Club of Surprise: Prospective Member Application
The Rotary Club of Surprise is a business/social networking and active service club with projects locally, nationally and internationally. Our impact on communities and building future leaders is rooted in a strong membership of caring volunteers. We thank you for your interest in joining The Rotary Club of Surprise.
Email Address
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Full Name
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Do You Have a Nickname?
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Address
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City
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State
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Zip Code
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Cell / Smart Phone Number
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Date of Birth
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Have you ever been a member of a Rotary Club?
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No
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Why do you want to join the Rotary Club of Surprise?
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How did you hear about the Rotary Club of Surprise?
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Current Member
Social Media
Newspaper
Other Rotarian
Rotary Club of Surprise Website
Rotary International Website
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What is your current / past occupation?
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Are you interested in getting involved with the Chapter?    
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Board Member
Leadership Position (President, Secretary, etc.)
Committees Member (Membership, Recruiting, Service Projects, etc.)
Committee Chair (Membership, Recruiting, Service Projects, etc.)
Meeting Set-Ups / Program Planning
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Section 2 of 2
Club Dates & Dues
Individual Primary Member
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Individual Primary Member ($250 annually)
Corporate Membership ($400 annually)
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add "Other"
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Corporate Primary member name
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Corporate Co-worker name #1
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Corporate Co-worker name #2
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Thank you for your application!
Your application will be reviewed by the Rotary Club of Surprise Executive Board and you will be contacted by the Membership Chairperson shortly.

If you have any questions, feel free to contact your Sponsor or send an email to rotaryclubofsurpriseaz@gmail.com.
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Email Address
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Full Name
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Do You Have a Nickname?
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Address
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City
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State
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Zip Code
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Cell / Smart Phone Number
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Date of Birth
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Have you ever been a member of a Rotary Club?
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Why do you want to join the Rotary Club of Surprise?
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How did you hear about the Rotary Club of Surprise?
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What is your current / past occupation?
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Are you interested in getting involved with the Chapter?    
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Club Dates & Dues
Individual Primary Member
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Corporate Primary member name
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Corporate Co-worker name #1
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Corporate Co-worker name #2
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Thank you for your application!
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