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JOIN US - Membership Proposal Form

Name : *

Short Name:

Gender:

Photograph:

Birth date: *

Email ID1: *

Email ID2:

Mobile: *

Employment Status: *

Company Name: *

Company website:

Designation:

Office Address: *

Off Tel:

Residence Address: *

Res Tel:

Rotary Mail to:

Spouse Name:

Short Name:

Gender:

Birth date:

Photograph:

Mobile:

Email ID:

Wed. Anniversary:

Academic Qualifications:

Professional Achievements:

Are you associated with any other Proffesional Body/ NGO? if yes, Give details:

Have you been a Rotarian with any other Club? If yes, give Club Name, Period of Membership & Reason for change:

Please list your other Skills, Hobbies and Interests (apart from Academic & Professional)

Please tell in your own words, how you feel you can connect to the Rotary Movement