Rotary Membership Referral form

Do you know a friend, family member, or colleague from your business or profession who has all the qualities of a good Rotarian? If you are an active member

of a Rotary club in good standing and know someone suited to Rotary, then consider referring them for membership in your club or in another Rotary club.

Every Rotarian has the privilege of seeking qualified Rotary club members. Expanding membership expands the ability to serve by helping clubs achieve a full

representation of the business and professional life of the community. Each new member brings a range of experiences and resources that can greatly strengthen

the organization and enhance the fellowship that Rotary offers.

General Qualifications: Rotarians are adults of good character and good business or professional reputation, who hold or have held an executive position with

discretionary authority in any worthy and recognized business or profession.

Once you have identified a good candidate, print out and complete the form below and submit it to your club secretary.

Your Information

£ I am an active Rotary club member. £ I am an honorary Rotary club member.

My Rotary Club name:______________________________

Club location:__________________

My full name:____________________________

Daytime phone number ___________________

E-Mail address: ______________________________________

Address 1: ______________________________________

City: _____________________________________ Country: ________________

I would like to refer the following person to:

£ my club ( Please give this completed form to your club Secretary )

£ Club name & location _________________________________

 

 

Candidate's Information:

First name: ____________________________

Last name: ________________________________

Daytime phone number______________          

E-Mail  Address:_________________________________________

Address 1: ______________________________________

Address 2: ______________________________________

City: _____________________________________ Country: ________________

Alternate address, business or residential.

Phone number:____________________________

E-Mail Address:________________________________

Company: ______________________________________

Address 1: ______________________________________

Address 2: ______________________________________

City: _____________________________________Country: ________________

If candidate is a former Rotarian, please list club(s) and dates of membership:

_____________________________________ _____________________________________

_____________________________________ _____________________________________

_____________________________________ _____________________________________

Comments regarding the referral for membership:

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________