New Member Information

Please complete the following information for our Furnitureland Rotary records. Thanks.
(Entry is required in all fields. If not applicable, enter "n/a")

Your Full Name
 for official Rotary records
E-Mail Address
How do you want your name to appear on your badge?
i.e.: nickname, salutation
Home Address (include city, state and zip)
Name of Business
Business Address (include city, state and zip)
What is your position in the business?
Please send Rotary information to

(We will send your Rotary bill to your email address)
Telephone Numbers

 

Home
Business
Fax
Cell

For purpose of demographic study, please give your birthdate:
 Month Day Year

Name of your spouse

First Name
Last Name if different than yours
What is the date of your anniversary? (mm-dd-yy)

Have you ever been a member of a Rotary Club

Yes .... No
If your last answer was "yes"
what was the name and location of the club?

 


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The Rotary name and logo are the exclusive property of Rotary International and are used here under Rotary International Internet Policy Guidelines. 
Special thanks to Tord Elfwendahl of the Stockholm Strand Rotaryklub (Sweden) for his incredible Rotary graphic images which we have used throughout this web site.

Please send comments, corrections, or concerns to:

Phil Morris
(336) 887-7435


Copyright © Phil Morris