image
To be completed by Prospective Member's Sponsor

Please Print

1. Name of Candidate:                                                                                     

2. Residence Address:                                                                                             
3. Business Address:                                                                                        
  
4. Name of Business:                                                                                        

5. Occupation:                                                                                                

6. Position/Title:                                                                                              

7. Home Phone:                     Business Phone:                     Email:                        

8. If new to area, prior residence:                                                                       

9. Length of residence in Thurston County:                                                           

10. Is your acquaintance with the candidate through:    Business     Social    (Circle)

11. Did candidate belong to another Rotary Club? If so, which Club:                          

12. Please give any additional information that would be helpful to the committee
     considering this proposal:                                                                              

                                                                                                                    

                                                                                                                    

13. Sponsor:                                                          Phone:                                

Please complete if known:

14. Month/Day of Birth:                   15. Spouse Name:                                         

16. Anniversary:                    17. Proposed Classification:                                     

Completed by Secretary:

Date Submitted to Secretary:                Date to Membership Committee:                 

Date Returned to Secretary:                  Date Presented to Board:                         

Date First Reading:                       Date Second Reading:                                     

Date Sponsor Notified:                     Date Inducted Into Club: