Rotary Club of Surprise: Prospective Member Application
Form description
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.
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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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City
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State
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State
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Zip Code
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Zip Code
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Cell / Smart Phone Number
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Cell / Smart Phone Number
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Date of Birth
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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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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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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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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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What is your current / past occupation?
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Are you interested in getting involved with the Chapter?
*
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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
Section title (optional)
Club Dates & Dues
Description (optional)
Individual Primary Member
*
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Individual Primary Member
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Individual Primary Member ($250 annually)
Corporate Membership ($400 annually)
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Corporate Primary member name
*
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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 #1
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Corporate Co-worker name #2
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Corporate Co-worker name #2
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Thank you for your application!
*
Title
Thank you for your application!
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Description (optional)
Your application will be reviewed by the Rotary Club of Surprise Executive Board and you will be contacted by the Membership Chairperson shortly.
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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?
Copy
No responses yet for this question.
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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Your application has been received and will be reviewed by the Rotary Club of Surprise Executive Board. You will be contacted shortly by the Membership Chairperson or a member of the Membership Committee.
If you have any questions, feel free to contact your Sponsor or send an email to rotaryclubofsurpriseaz@gmail.com.