Rotary Membership Application

Yerevan United Rotary Club

Please choose from the following:

Individual Corporate Non-Profit

MEMBER

Title:

First Name:

MI:

Last Name:

Suffix:

Nickname:

Birthdate:

Gender:

Home Phone:

Cell Phone:

Sponsor(s)

Sponsor 1:

Endorser 1:

Endorser 2:

Home Address

Address 1:

Address 2:

Address 3:

City:

State:

Country:

Postal Code:

Previous Rotary Clubs

Club#

Club Name

City

State

Date Joined

Date Resigned

Previous Club E-mail:

CLUB PARTICIPATION AND ACHIEVEMENTS: i.e., offices held in the club and which year.

BIO AND DESCRIPTION: i.e., personal and professional background

EDUCATION AND DEGREES:

HOBBIES AND INTERESTS: i.e., golf, fishing, and hunting