New Member Proposal Form

Our Club

New Member Proposal Form

This form is to be completed by Peoria-North Rotarians when recommending prospective members to the club.

Please note that those fields with * are required to be completed.

Proposed Member - General Information

Full Name *

Nickname

Spouse

Birthdate *

Preferred Email (for billing) *

Is this individual available for the 11:45a-1:15p weekly meeting? *

Work Shirt Size *

Proposed Member - Home Information

Home Street Address

Home City

Home State

Home Zip Code

Home Phone

Proposed Member - Business Information

Business Name

Position/Title

If Retiree, what position was held when this indiviual retired?

Business Street Address

Business City

Business State

Business Zip Code

Business Phone

Business Fax

Mobile Phone

How long at this job?

Proposed Member - Other Information

If former Rotarian, list clubs and dates

How long have you known this person? *

Other club members that would know this individual *

Activities that would enhance consideration as a Rotarian *

Rotarian Information

Sponsor Name *

Sponsor Email Address *

Upon submitting this application, you will be notified by email if this application has been received and returned to our Club's home page.

To be effective, a Rotary club needs members. Our club’s ability to serve the community, support The Rotary Foundation, and develop leaders capable of serving Rotary beyond the club level is directly related to the size and strength of our membership base.

Thank you for taking that first step in helping our Club grow!