Rotary 101 - New Member App

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Confidential Application for Membership to the

King of Prussia Rotary Club

P.O. Box 60187

King of Prussia, PA 19406

BUSINESS/PROFESSIONAL INFORMATION

Applicant: ______________________________________________________ 

Date of Application: _________________________

Business/Employer: _______________________________________________________ 

Business Address: _________________________________________________________ 

Business Phone: _____________________Business Cell Phone: ____________________ 

Business E-mail_______________________   Personal E-mail:______________________

Position/Title: _________________________

Brief Description of Business Responsibilities: __________________________________

________________________________________________________________________  

________________________________________________________________________

Business/Professional History: _______________________________________________

________________________________________________________________________

________________________________________________________________________

How Did You Learn About Rotary? :__________________________________________

Previous Club/Rotary Memberships: __________________________________________

Club Sponsor: __________________________

Please complete this application and mail to the above address for consideration.

To be Completed by Club:

Acceptance Date: _______________________ Induction Date: _____________________

King of Prussia Rotary Club                                                                  

Confidential Application for Membership

(To be completed after applicant’s membership is approved.)

(All information is confidential. Required fields [*])

PERSONAL INFORMATION:  (For Club Manual, Roster and Website)

Applicant:[*] _________________________________ Nickname: _____________________ 

Birthday (Month & Day): _________________   Place of Birth: ________________________

Home Address [*] ____________________________________________________________

Home Phone: [*] _________________________ Cell Phone: __________________________

E-mail: [*] _____________________________

Previous Residence(s):_____________________________________________________

Name of Spouse: ________________________ 

Month & Day of Wedding Anniversary: ________________

Name & Ages of Children: _________________________________________________

EDUCATION

College: ___________________________ Graduate School: _______________________

Club & Professional Association Memberships: __________________________

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Community Service; Military Service: _________________________________________

________________________________________________________________________

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Personal Interests: ________________________________________________________

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Preferred Address & E-mail Contact [*] for Website: _____________________________

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