Denver Mile High Rotary - Becoming A Member

When you "Submit" you are also acknowledging that, if you are approved for membership and inducted, you agree to the $250 initiation fee and that quarterly dues of $200 should be paid promptly after receipt of the invoice.

Date

Candidate

Full name

Usually Go By

E-Mail Address

Business

Name

Phone

Address

Fax

City

Cell

Position

State

Zip

Responsibilities

Years With Firm

Residence

Address

City

Zip

Phone

Personal Data

Date of Birth

Place of Birth (City, State, [Country])

Other
Memberships

Interests

Spouse/Partner's

Name

Month/Day of Birth

Children's Names

Additional Data

Other Service Clubs/Community/Social

Other Rotarians Who May Know Candidate:

1) Name, Address, Phone

2) Name, Address, Phone

Other Qualifications
(Leadership Roles, Comments)

Sponsoring Member