Get Member Sheet Club Form

Rotary Club of Evansville Member Information Sheet Members are requested to complete this form and return it to Mail Rotary Club of Wauwatosa 910 Satinwood Ct. Brookfield WI 53005 or Fax 262-796-8233 NAME ADDRESS Title First Name Last Name Nickname/Call Name Middle Name Suffix Male Home Address City High School district you reside in State Zip Code Other/Vacation Address Female Business Address Send Correspondence To Other Address Letter Fax E-mail Send Invoice For Dues To The club s weekly newsletter Rotations is sent via e-mail unless otherwise notified by the member. In such case the newsletter will be mailed* Do not send the newsletter by e-mail* Please mail it to my home address other address as written above. PHONE Home Business Other FAX Assistant Mobile Preferred fax check one E-MAIL Preferred e-mail check one COMPANY WEBSITE BUSINESS DETAILS Company Name Company s Principal Activity Occupation Title/Position RETIRED If yes please include Company Name and Title/Position at time of retirement. PERSONAL DETAILS Date of Birth mm/dd/yy Degrees/Diplomas Rotary Achievements e*g* Past District Governor 1988/1989 Paul Harris Fellow 1999 etc* Achievement Rotary Year Achieved Previous Membership in Rotary/Other Clubs Club Name Date From Date To Miscellaneous Achievements Community positions Special projects Interests and Hobbies FAMILY DETAILS Spouse First Name Anniversary mm/dd/yy Spouse is Rotarian Spouse s Rotary Club Name Children Gender CLUB DETAILS to be completed by office Badge Member Type Honorary Active-Ordinary Active-Exempt Date Joined Classification Sponsor s Name Header Sub. Brookfield WI 53005 or Fax 262-796-8233 NAME ADDRESS Title First Name Last Name Nickname/Call Name Middle Name Suffix Male Home Address City High School district you reside in State Zip Code Other/Vacation Address Female Business Address Send Correspondence To Other Address Letter Fax E-mail Send Invoice For Dues To The club s weekly newsletter Rotations is sent via e-mail unless otherwise notified by the member. In such case the newsletter will be mailed* Do not send the newsletter by e-mail* Please mail it to my home address other address as written above. In such case the newsletter will be mailed* Do not send the newsletter by e-mail* Please mail it to my home address other address as written above. PHONE Home Business Other FAX Assistant Mobile Preferred fax check one E-MAIL Preferred e-mail check one COMPANY WEBSITE BUSINESS DETAILS Company Name Company s Principal Activity Occupation Title/Position RETIRED If yes please include Company Name and Title/Position at time of retirement. PHONE Home Business Other FAX Assistant Mobile Preferred fax check one E-MAIL Preferred e-mail check one COMPANY WEBSITE BUSINESS DETAILS Company Name Company s Principal Activity Occupation Title/Position RETIRED If yes please include Company Name and Title/Position at time of retirement. PERSONAL DETAILS Date of Birth mm/dd/yy Degrees/Diplomas Rotary Achievements e*g* Past District Governor 1988/1989 Paul Harris Fellow 1999 etc* Achievement Rotary Year Achieved Previous Membership in Rotary/Other Clubs Club Name Date From Date To Miscellaneous Achievements Community positions Special projects Interests and Hobbies FAMILY DETAILS Spouse First Name Anniversary mm/dd/yy Spouse is Rotarian Spouse s Rotary Club Name Children Gender CLUB DETAILS to be completed by office Badge Member Type Honorary Active-Ordinary Active-Exempt Date Joined Classification Sponsor s Name Header Sub.