How do I become a member?

Bound Brook-Middlesex Rotary Club

Membership Application

Applicant's Name: ________________________________________________________

Sponsored By: ___________________________________________________________

Type of Membership:

Active:_____

Senior Active:_____

Honorary:_____

Active Member

Past Service Member (No Classification)

Senior Active Member (No Classification)

Previous Rotary Membership ______________________

Classification: ___________________________________________________________

Personally & actively engaged in the business or profession covered by this classification and have my place of business or residence located within the territorial limits of the Club or within the corporate limits of the city in which the Club is located or within the territorial limits of an immediately adjoining Club.

I understand that it will be my duty, if elected, to exemplify the object of Rotary in all my daily contacts and activities, and, at all times to abide by the constitution and by-laws of the Club.

I agree to pay annual dues of $ 150 in accordance with the by-laws of the Club. I hereby give my permission to the Club to publish to its members my name and proposed classification.

Business Name: __________________________________________________________

My Position: _____________________________________________________________

Business Adddres:

________________________________

Phone: __________________________

Fax: ____________________________

Email: __________________________

Home Address:

________________________________

Phone: __________________________

Fax: ____________________________

Email: __________________________

Date of Birth: ____/_____/________

Spouses Name: ____________________________ Date of Birth: ____/_____/________

Wedding Anniversary Date: ____/_____/________

Signature

Date