La Grande Rotary Member Nomination Form
Proposed member______________________________
Home address of proposed member
____________________________________________________________________________________________________________________________________________________________
Work phone ______________________
Home phone______________________
Cell ph__________________________
Email __________________________
How do you know this person?____________________________________________________
____________________________________________________
How long in area?_________________________
Outside activities _______________________________________
___________________________________________________
Community service ____________________________________________________
____________________________________________________
____________________________________________________________________________________________________________________________________________________________
Occupation/title ____________________________________________________
Employer ____________________________________________
How long?_______________________
Has this person been a Rotarian previously? Yes______________ No______________ Don’t know___________________
Why do you think this person would make a good Rotarian?
____________________________________________________________________________________________________________________________________________________________
In what area/activity of the club would this person be an asset?____________________________________________________________________________________________________________________________________________________________
Rotarian proposing new member:____________________________
Date____________________
Please return to Club Secretary
For Club Use Approved by Membership Committee: Date________________
Approved by Board of Directors: Date________________
A WORD version of this forma may be found at: