Membership Application

Indentification

Date *
Name *
Nick Name
Date of birth *
Spouse

Personal Contact

Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Home Phone
Mobile Phone
Email *

Business Contact

Business / Company Name
Title / Classification
Business Address
Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeCountry
Business Phone

Previous Rotary Affiliation

Rotary Club
Rotaract Club
Interact Club
RYLA
Other

Referred By

Name
Rotary Club
Checkbox
ParentColleagueFriendOther

Verification

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Have you determined that the Hillsboro Rotary Club is the perfect fit for you? If you answered yes, working with your sponsor, fill out the application below.

Download this form and return to the Membership Chair