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Membership Form
Membership Form
q@bluemillion.com
2024-10-14T18:20:57+00:00
Membership Proposal Form
I am proposing ________________________________________ for active membership in the Rotary Club of Lexington.
Home Address
Street Address
ZIP / Postal Code
Phone
Business Name
Phone
Business Address
Street Address
ZIP / Postal Code
Cell
Nature of Business
Email
Position:
Proprietor
Partner
Corporate Officer
Manager
Community Leader
Other
Please describe:
Title:
How Long Held:
Description of Responsibilities
Birth Date
MM slash DD slash YYYY
Previous Membership in Rotary?
Yes
No
Year
Where
Previous Membership in Rotaract?
Yes
No
Year
Where
Civic/Charitable Involvements, including years of service and offices held:
SPONSOR INFORMATION
Name
First
Last
Primary Phone
How long have you known the proposed member?
Two Additional References (One must be an active member of the Rotary Club of Lexington)
Name
First
Last
Phone
Name
First
Last
Phone
FOR MEMBERSHIP COMMITTEE:
Proposal Received
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