Lake Chelan Rotary Membership Application Application Date* MM slash DD slash YYYY Name of Rotarian Sponsoring Applicant:* First Last Sponsoring Rotarian Email* Enter Email Confirm Email Name of Proposed Member* First Last What is Applicants Birthdate* MM slash DD slash YYYY Is Proposed Member Retired?*NoYesName of Spouse or Partner First Last What is Applicants Anniversary Date MM slash DD slash YYYY Applicants Email Address:* Enter Email Confirm Email Name of Proposed Members Business: Proposed Members Mailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Proposed Members Physical Address:* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Applicants Home Phone Number:*Applicants Business Phone Number:*Applicants Mobile Telephone Number:*Is Applicant a Former Rotarian*NoYesRotary Membership NumberIs Applicant an Active Rotarian at Another Club*NoYesIs Applicant Transferring from Another Club*NoYesName of Club From: MM slash DD slash YYYY To: MM slash DD slash YYYY Is Applicant A "Paul Harris Fellow":*NoYesMembers Classification:*Please ChooseAccounting/FinanceAdvertising/Public RelationsAerospace/AviationArts/Entertainment/PublishingAutomotiveBanking/MortgageBusiness DevelopmentBusiness OpportunityConstruction/FacilitiesEducation/TrainingEnergy/UtilitiesEngineeringGovernment/MilitaryHealthcareHospitality/TravelHuman ResourcesInsuranceInternetLaw Enforcement/SecurityLegalManagement/ExecutiveManufacturing/OperationsMarketingNon-Profit/VolunteerReal EstateRestaurant/Food ServiceRetailSalesScience/ResearchTechnologyTelecommunicationsTransportation/LogisticsOtherAtivities that would enhance consideration as a Rotarian:*Why do you want to be a Rotarian?*NameThis field is for validation purposes and should be left unchanged. 34148
