Clayton Rotary Club Membership Application Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.TitleDr.MissMr.Mrs.Ms.Rev.Name *FirstLastSuffixSr.Jr.IIIIINickname or Preferred Name Name for Club Nametag *Please put the name you would like to use for your Rotary Club NametagBusiness or Vocation Title For Club Nametag *Under your name it says what business or vocation you are in. What do you want associated with you on your name tag? It can be general or a specific job title.Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender *Email *Home PhoneCell PhoneClayton Rotary Club Member Sponsoring You *Clayton Rotary Club Rotarian that is sponsoring your application. If you don't have one, please visit our club and meet our members and we'll get you a sponsor!Additional Sponsor Name (If Applicable)Only one sponsor is required, but if you have more than one sponsor list additional name(s) above.Home AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCompany NameBusiness AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeBusiness Position / Job TitlePreferred Mailing Address *BusinessHomeAre You Married?YesNoIf married, what is your Anniversary date?MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Spouse/Partner NameFirstLastSpouse Nickname or Preferred NameIs your Spouse/Partner a current Rotarian?YesNoClub NumberClub NameCityStateDate JoinedMM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920CLUB PARTICIPATION / ACHIEVEMENTS i.e. offices held in clubs and which yearDEGREESHOBBIES & INTERESTS: i.e. sports, reading, etc. *COMMUNITY LEADERSHIP & OTHER COMMENTS. Are you involved in community organizations (board member, volunteer, etc.) projects, outside organizations. *Why do you want to join Rotary? *What interested you in wanting to join our Club/Rotary?Your Photo - Headshot only * Click or drag a file to this area to upload. Please upload a headshot of you in .jpeg or .png format. This will be posted on our Club website on the Members' page if you are approved. Photo Requirements: Only headshots. No other people, animals, or advertising in the photo. Clear photo-not dark or blurry with a simple background. Submit Save and Resume Later Your form entry has been saved and a unique link has been created which you can access to resume this form. Enter your email address to receive the link via email. Alternatively, you can copy and save the link below. Please note, this link should not be shared and will expire in 30 days, afterwards your form entry will be deleted. Copy Link Email * Send Link
