Rotary Club of Chisago Lakes
Applicant Name: ____________________________________________________________ Nickname: ________________________
First Middle Last
Home Address: ________________________________________ City: _________________________ State: ______ Zip: _________
Home Phone: __________________ Home Fax: ___________________Home Email: ______________________________________
Business Name: ____________________________________________________________Business Phone: ____________________
Business Address: City: _________________________State: _______ Zip: _________
Business Fax: _______________ Business Email: ______________________________________ Mobile: ______________________
Previous Rotary Club Membership? Yes: __ No: __ Name of Club: ______________________________________________________
Office(s) Held: _______________________________________________________________________________________________
Other significant and/or service club membership(s) and offices held: ____________________________________________________
Please include employment, educational and personal background as desired:
All Rotarians are asked to serve on at least one committee. Please place a check by your area of interest and as an indication of your involvement on that committee.
Club Administration ___________
Community Grants ____________
Outreach and Service _________
Public Relations ______________
Web/Social Media _____________
Rotary Foundation _____________
Strategic Planning _____________
Sponsor should bring the potential member to several meetings to assess his/her interest. Upon the approval of the Board and Membership, the applicant will be invited to join the club.
Please see the Rotary Club of Chisago Lakes’ brochure for more information or visit www.chisagolakesrotary.org.
Attendance: There is a 60% minimum attendance requirement annually. Member should not miss more than three meetings in a row.
COSTS: Annual Dues & Assessments (inc. weekly meals) $500 annually (billed $125 quarterly)
While your dues may be mailed/emailed to your business, please remember that all dues and assessments are the responsibility of you, the member and not your business or organization. We look forward to a long term relationship as a member. But should it ever be necessary, resignations must be submitted to the Board in a letter of resignation.
Applicant Signature: ________________________________________________ Date: ____________________________________________________
Sponsor Name: ________________________________________ Reason for suggesting applicant: ________________________________________
_____________________________________________________________________________________________________________________________ Sponsor Signature: __________________________________________________________Date: ____________________________________________
Sponsor should forward completed application to the club secretary for presentation to the Board at an upcoming meeting.