Membership Application

La Grande Rotary Membership Application Form

Name ________________________________________________________________________________________________________

I, the undersigned, being familiar with the requirements for and conditions of membership, hereby make application as an Active Member of the La Grande Rotary Club. I understand that it will be my duty to exemplify the Object of Rotary in all my daily contacts and activities, and at all times to abide by the constitution and bylaws of the club. I understand that part of my membership dues will pay for the International Club memberships and part will offset costs for a weekly lunch. I agree to pay the initiation fee of $50 and the monthly dues of $60 in accordance with the bylaws and policies of the club.

Signature ____________________________________________________

Date _____________________________________________

I would like to join Rotary because:

___________________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________

Business Name _______________________________________________________________________________________________________

Position/Job Title ____________________________________________________________________________________________________

Business Mailing Address ___________________________________________________________________________________________

________________________________________________________________________________________________________

Business Phone _________________________________

Fax _____________________________________

Home Mailing Address ____________________________________________________________________________________________________________________________________________________________

Home Phone ___________________________________

Cell __________________________________________

Email Address _______________________________________

Date of Birth (mo/day/year) ______________________________

Spouse’s Name _______________________________________

Please return this form with your $50 initiation fee to the club Secretary.  Thank you!

A WORD version of this application can be found here:

membership-application-2016