Corporate Membership Application, Rotary Club of Wellington

Corporate Membership Application

Organisation Details

Organisation Name:

Physical Address:

Mailing Address:

Website:

Telephone:

Rotary Information

Supporting members:

Personal Information - Primary Member

Name:

Position in Organisation:

Business Phone:

Business Email:

Cellphone:

Home Email:

Are you a current or past Rotarian:

YES NO

If Yes above note Club name and approximate membership dates:

Personal Information - Associate Member 1

Name:

Position in Organisation:

Business Phone:

Business Email:

Cellphone:

Home Email:

Are you a current or past Rotarian:

YES NO

If Yes above note Club name and approximate membership dates:

Personal Information - Associate Member 2

Name:

Position in Organisation:

Business Phone:

Cellphone:

Home Email:

Are you a current or past Rotarian:

YES NO

If Yes above note Club name and approximate membership dates:

Personal Information - Associate Member 3

Name:

Position in Organisation:

Business Phone:

Business Email:

Cellphone:

Home Email:

Are you a current or past Rotarian:

YES NO

If Yes above note club name and approximate membership dates: