Membership Application

Personal Information

First Name *

Last Name *

Home Address

Street Address *

Address Line 2

City *

State / Province / Region *

ZIP / Postal Code *

Country *

Personal Email *

Personal Phone *

Business Information

Name of Business

Business Street Address

Business Address Line 2

Business City

Business State / Province / Region

Business ZIP / Postal Code

Business Country

Title

Classification

Business Phone

Fax

Additional Information

Birthday *

Former Rotarian Choose… Yes No

Spouse First Name

Spouse Last Name

Wedding Anniversary

Activities or interests that would recommend our consideration of you as a Golden Rotarian

Sponsoring Rotarian

Applicant Agreement

I understand that it will be my duty, if elected, to exemplify the Object of Rotary in all my daily contacts and activities and to abide by the constitutional documents of Rotary International and the Rotary Club of Golden, CO. I agree to pay an admission fee of $65.00 with my application and dues of $225.00 per quarter, and give my permission to the Club to publish my name and proposed classification to its membership. Enter your full name below.

Full Name *

Typing your full name confirms your agreement with the statement above.