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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: __________________________

 

_______________________________________________________________________

 

_______________________________________________________________________

 

Community Service; Military Service: _________________________________________

 

________________________________________________________________________

 

________________________________________________________________________

 

Personal Interests: ________________________________________________________

 

________________________________________________________________________

 

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

 

________________________________________________________________________