Membership Application Rotary Club of Sacramento

Membership Application Rotary Club of Sacramento

Membership Application Name: Badge Name: (First) (MI) (Last) Your name and proposed classification will be published in our weekly newsletter, The Pulse. You will then be contacted via email scheduled for an orientation session and induction date. Please allow between 2 and 4 weeks for the membership processing and approval. Male Female Birthdate: Place of Birth Member Sponsor #1 Signature: I am willing to mentor this member during his/her first year. Member Sponsor#2: Signature: _ I am willing to mentor this member during his/her first year. Business Information Name of Firm / Company: Position / Title: Type of Business: Business Address (Location): City/Zip: Business Address (Mailing): City/Zip: Phone: ( ) _- ext Email Website: Residence Information Residence Address: City/Zip: Home Phone: ( ) - Mobile Phone: ( ) - Personal E-mail:

Previous Rotary Service Previous Rotary Club(s): Dates of Membership: Did you leave in good standing (all debts have been paid)? Yes No Prior Rotary Office(s) Held: Are you a Paul Harris Fellow? Yes No Level Achieved, if known: Are you related to a Rotary Club of Sacramento member? Yes No If so, what is the member s name? Family & Hobbies Partner: Preferred Name: Child : Child: Child: Child: Interests (sports, hobbies, Theatre, etc.): Musical Instruments Played: Languages Spoken/Written: Education & Military Educational Institution(s): Degree(s): Educational Institution(s): Degree(s): Military Branch of Service: Rank: Veteran:

Membership Levels Individual Membership Requirement: Membership belongs to the individual Initiation Fee (one-time): $250 $1,695 per year (billed quarterly at $423.75 per quarter). Dues are inclusive of fees for weekly luncheons, Networking Nights, President s Breakfasts and Firesides. Other events are invoiced separately. Transferring/Reinstating Members Reduced Initiation Fee of $100 Nonprofit Company Name: I am establishing a Nonprofit Membership I am replacing in our existing Nonprofit Membership Membership Requirements: Nonprofit Entity r etains m em bership and m ay replace m em bers upon r e- quest. Initiation Fee (one-time): $250 per person $850 per person, per year (billed annually) Dues do not include fees for weekly luncheons, Networking Nights, President s breakfasts, Firesides and other events. Other events will be invoiced separately. Corporate Company Name: I am establishing a Corporate Membership I am replacing in our existing Corporate Membership Membership Requirements: Corporate Entity retains m em bership and m ay replace m em bers upon request. Initiation Fee (one-time): $250 per person $850 Per person Dues do not include fees for weekly luncheons, Networking Nights, President s breakfasts and Firesides. Other events will be invoiced separately. Under 40 Membership Requirement: Membership belongs to the individual Initiation Fee (one-time): $100 $566 per year (billed quarterly at $141.50 per quarter). Dues do not include fees for weekly luncheons, Networking Nights, President s Breakfasts and Firesides. Other events are invoiced separately.

Provide Professional Headshot: Please email a professional headshot in (high resolution, JPEG format) to info@rotarysacramento.com. This is for the online and printed directory. If you do not have a professional headshot, please contact info@rotarysacramento.com. Provide one-time Initiation Fee Payment: My check is included (payable to Rotary Club of Sacramento with Initiation Fee in memo line) Please bill my Credit Card for the following Initiation Fee: $ Credit Card Type (please circle): VISA American Express Credit Card Number: Expiration Date: / Name on Card (print): CVS Code: _Billing Zip: Cardholder Signature: Date: Correspondence and Payment Preferences Preferred Mailing Address: Residence Address Business Address Preferred email for Club correspondence and announcements: Personal Business Billing Send Email invoices to: Personal Email Business Email cc e-mail address for invoices/statements: I am interested in automatic credit card payments and would like Accounting to contact me. Applicant Signature: Date: I certify that I am qualified for membership by my current or former status as a business, professional, or community leader, or as a Rotary Foundation alumnus. I understand that, if accepted for membership, it will be my duty to abide by the constitutional documents of Rotary International and the Club. I agree to pay any initiation fees required by the Club and to pay annual dues in accordance with the Cub bylaws. I give permission to the Club to publish my name and proposed classification to its membership. Return to: 1451 River Park Dr. #120, Sacramento, CA 95815 or email to: info@rotarysacramento.com