Rotary of Andover Membership Application | Rotary Club of Andover, Ks

Are you interested in joining the Rotary Club of Andover? We would love to have you in our group! Simply fill out the application below and we will be in touch with you soon.

Title

First Name *

Last Name *

Suffix

Current Firm / Business Name

Position with current firm/business

Date of Birth

Month

Day

Year

Type of Membership *

Individual

Business

If Business, select one:

Business's Designated Member

Business's Additional Member

Personal Phone

(XXX) XXX-XXXX

Business Phone

(XXX) XXX-XXXX

Email Address *

Preferred Mailing Address *

If transferring or former Rotarian, list dates of membership

From date and to date

If transferring or former Rotarian, list previous club name:

Recent transfer:

Yes

(one year or less)

If an RI program participant or Foundation alumnus/a, list program(s) and date(s):

Activities that would enhance consideration as a Rotarian:

Electronic Signature *

I understand that, if accepted for membership, it will be my duty 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 club. I agree to pay the annual dues of $660 in accordance with the bylaws of the club. I hereby give permission to the club to publish my name and proposed classification, if applicable, to its membership.

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