Membership Application

Date

Name

Birth Date

Company Name

Position/Title:

Business Address:

Business Phone:

Home Address:

Home Phone:

Cell Phone:

Education:

Spouse or significant other:

Please indicate your preference for being contacted:

Other Rotary Affiliation (if any):

Dates:

I understand that it is my duty, if elected, to exemplify the Object of Rotary in all my daily contacts and activities and to abide by the constitutional documents of Rotary International and the Rotary Club of SLC. I agree to pay $85 in monthly dues in accordance with the Bylaws of the club.

I hereby give permission to the club to publish my name for member information.

I the undersigned, make an application for membership in Club 24.

Official Publication

By accepting membership in this club, you will receive a subscription to The Rotarian the official monthly magazine of Rotary International

Please call Pearl Wright at the Rotary of SLC office to establish monthly credit card payments. The office phone number is 801-363-8415.

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