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: