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Rancho Santa Fe Rotary
P.O. Box 2576
Rancho Santa Fe, CA 92067
Membership Proposal Form
Candidate: Date:
Mail Rotary magazine to home:____ or office:____ or on line:____
Company Name:
Business Title (Rotary Classification):
Business Address:
Business Phone:
Home Address:
Home Phone:
Email:
Cell Phone:
Related Activities:
Why do you want to be a Rotarian?
College/University:
Birth Date:
Spouse’s Name: Anniversary Date:
Sponsor:
FINANCIAL RESPONSIBILITY: I hereby agree to provide Initiation dues of $ 200.00* as well as one quarter’s dues of
$325 with this application for membership. The payments will be processed only after the final Board approval is secured.
I further agree to keep my membership account current within 30 days of being billed. For your convenience, may we charge your credit card monthly or quarterly for your dues? Yes____ No____ cc Number______________________Exp._______
Name: Date:
*$100 for former Rotarians
**************************************************************
For office use:
Application Received: __________ Board: ______
Ten Day Letter: _____ Induction Date: ______
Rotary International ID Number (if former Rotarian): ___________________
Rosters: RI ________ District ________ Club ________ Darcy ____