Alexandria Central Rotary | Rotary Club Application

Thank you for your interest in Rotary membership. We are a progressive organization of professional and community leaders.

Note: Submitting an application does not guarantee membership.

Sponsor name is required to complete the application.

Today's Date*
Name*
First Last
Email*
Have you been ever been a member of Rotary:*
If, so what club(s)*
Suggested Classification:*
Home Information
Home Address*
Street Address Address Line 2 City State ZIP Code
Cell Phone
Work Information
I'm currently:*
Employer:*
Other Information
Birthday Month and Date (do not include year)*
Please indicate your area(s) of interest (select two):*
Alexandria West Rotary Club has many avenues for Rotarian involvement. All members are encouraged to participate actively on at least two committees. Examples of projects are summarized on this page. Please indicate your area(s) of interest.
Do you have any special interests and/or talents:
Any community involvement (past and present):
Why do you want to be a Rotarian?*
Alexandria Central Rotary Sponsor?
Do you have a sponsor? If so, please let us know who will be your sponsor. If you don't have one don't we will have a member sponsor you.
Sponsor Name
First Last
Applicant Certification:
- I understand that it will be my duty, if elected, to exemplify the Object of Rotary in my daily contacts and activities, and to abide by the constitution and by- laws of the club.
- I understand that part of my membership dues will provide me with an annual subscription to The Rotarian magazine or an approved and prescribed regional magazine as may be applicable.
- I agree to pay any applicable admission fees and the quarterly dues in accordance with the by- laws of the club.
- I hereby give permission to the club to publish my name and proposed classification to its members. I confirm my commitment to meet Rotary’s attendance requirement of at least 50% of weekly meetings each month.
- I agree to help raise money towards whatever club goal is set for the current year for our Rotary club’s charitable contributions.
- I accept my responsibility to be an active club member by serving on club committee(s).
- I understand the opportunities to make financial contributions to the Alexandria West Rotary Club Foundation and the Rotary International Foundation.
Applicant Signature*
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Alexandria Central Rotary Club Application

Home Information

Work Information

Other Information

Alexandria Central Rotary Sponsor?

Applicant Certification:

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