Chisago Lakes Area Rotary Club Membership Application

Applicant Name: ______________________________________________________________

                                                       First                     Middle                     Last

Type of Membership: ⬜ Individual ⬜ Corporate Individual

Mailing Address: ____________________________________________________________________________

Individual Phone: _________________________________________

Individual Email: __________________________________________

Previous Rotary Club Membership? ⬜ Yes ⬜No

If Yes, Name of Previous Club: _____________________________________________

FOR CORPORATE MEMBERSHIP (If Applicable):

Corporation Name: ____________________________________________________________________________

Corporation Mailing Address: ______________________________________________________________________

Corporation Phone: ______________________________________

Corporation Email: _______________________________________

Areas of Interest (check all that interest you)

⬜ Global Outreach ⬜ Member Relations ⬜ Public Relations ⬜ Community Service ⬜ Club Administration

⬜ Social Media/Tech ⬜ Youth Engagement ⬜ Finance/Grants ⬜ Fundraising/Foundation

Applicant Signature: _________________________________________ Date: _____________​