Rotaract membership application (PDF)

Beaches Rotaract
Membership Application

Name _____________________________________________________________________
Date of birth _____/______/________ Email: ______________________________________
Home address ________________________________________________________________
Home/cell phone (______)_______-__________ Work Phone (_______)_______-____________
Occupation: Title and organization: _________________________________________________
(If not presently employed, indicate career goals) ______________________________________
College(s)/university(ies) attended and degree(s)
earned:________________________________________________________________________
List of all the clubs/organizations to which you have belonged and indicate any offices you hold or have held:
______________________________________________________________________________
______________________________________________________________________________
Rotaract engages in both community and international projects. The club’s programs are designed to focus on
professional development, to stimulate knowledge, and to promote acceptance of high ethical standards in
business and professional life. Are you willing to give time to these activities? ___________
Have you had any affiliation with Rotary, Interact, or Rotaract either in the past or present?
______________________________________________________________________________
______________________________________________________________________________
Please prioritize your reasons for joining Beaches Rotaract (rank each from 1 to 4):
Community service _______ Professional development ________
Social activities ________ Leadership opportunities ___________
How did you hear about Rotaract?
______________________________________________________________________________
By signing below I understand and accept the principals and ideals of Rotaract and agree to comply with and be
bound by the “Standard Rotaract Club Constitution and by-laws of the club”. I also understand that should I be
accepted into membership I am expected to participate in group activities to the best of my abilities.
Signed _________________________________________Date _____/_______/_________

*Dues for Rotaract are $100 per year per member. Please bring this completed application & membership dues to
a Rotaract Club meeting & submit it to the Club President or Vice President.
The following information to be completed by Club Secretary:
Date Received:____________
Date of Board Vote:_____________

Date of Induction:______________