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: __________________________________
________________________________________________________________________
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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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