Membership Proposal Form Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Part A PrefixMr.Mrs.Ms.Dr.Prof.Mx.Name *FirstLastPosition Title *Business Name *Business Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeBusiness PhoneBusiness Email *Home AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeHome PhoneMobile Phone as Membership Position Personal Email *Preferred Email Address: *HomeBusinessBirthdate *Marital StatusSingleMarriedSpouse's NameProposed ClassificationIf rejoining or a former Rotarian, list most recent club information: Have you been a member of Rotary International in the past? *YesNoIf yes, complete the following information about your previous Rotary membership. Former Club NameStart Date of MembershipEnd Date of MembershipPrevious Rotary Membership IDIf an RI program participant or Foundation alumnus/a, list program(s) and date (s):Activities that would enhance consideration as a Rotarian:Have you discussed the Purpose of Rotary and the Responsibilities of Membership (Attendance, Service, Financial, Etc.)? *YesNoPlease list the name of your sponsor. A current member of the Rotary Club of Knoxville.Part B I, the undersigned, being familiar with the requirements for and conditions of membership, hereby make application for active membership in the Rotary Club of Knoxville. If membership in Rotary Club of Knoxville is approved, I understand that it will be my personal responsibility: (1) to exemplify the Object of Rotary in all my daily activities; (2) to abide by the Constitution and By-laws of the Rotary Club of Knoxville; (3) to pay my annual $1,200 dues to the Rotary Club of Knoxville; and (4) to pay a one-time admission fee of $250 to the Rotary Club of Knoxville. The annual dues provide a personal subscription to the official Rotary International magazine plus pays for weekly lunches and annual expenses associated with being a member in good standing with the Rotary Club of Knoxville and Rotary International, in accordance with the By-laws of the club. I hereby give permission to the Rotary Club of Knoxville to publish my name, occupation, and contact information to its members. Proposed Member's Signature * Clear Signature Date *Submit
