Application - PORTLAND ROTARY CLUB

Membership Application Form

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What type of Membership are you applying for? *

New Member Portland TN Rotary Transfer to Portland TN Rotary

Name *

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Last

Office Email *

Personal Email *

Select One Email Preference *

Address *

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City

State

Zip Code

Country

Cell Phone Number *

Month, Day and Year of Birth *

Position Title or Description: *

Business Address *

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City

State

Zip Code

Country

Home Phone Number *

Office Phone Number *

Spouse's Name *

Previous Rotary Clubs *

Provide some Vocational and Personal background details that will enhance your activities as a Rotarian: *

I hereby certify that if accepted to Membership of the Rotary Club of Portland, that I as a Rotarian, will exemplify the Object of Rotary in all my daily contacts and will abide by the constitutional documents of Rotary International and the club. I agree to pay an admission fee and dues in accordance with the bylaws of the club. *

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By typing your name you are signing the application *

Date *

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