Clayton Rotary Club Membership Application Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Please fill out this application completely to be considered for membership. NOTE: For ONLINE applications, if you experience any technical difficulties with this application or have questions, please email: RotaryClubClayton@gmail. com. Please describe the problem you are experiencing and we will respond. FOR OFFLINE APPLICATIONS: If you have any questions please email rotaryclubclayton@gmail.com.Title *Dr.MissMr.Mrs.Ms.Rev.Name *FirstLastSuffixSr.Jr.IIIIINickname or Preferred Name Name for Club Nametag *Please put the name you would like to use for your Rotary Club NametagBusiness or Vocation Title For Club Nametag *Under your name it says what business or vocation you are in. What do you want associated with you on your name tag? It can be general or a specific job title.Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Gender * Photo Have Email *Home PhoneCell Phone *Clayton Rotary Club Member Sponsoring You *Clayton Rotary Club Rotarian that is sponsoring your application. If you don't have one, please visit our club and meet our members and we'll get you a sponsor!Additional Sponsor Name (If Applicable)Only one sponsor is required, but if you have more than one sponsor list additional name(s) above.Home Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeCompany Name *Business AddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeBusiness Position / Job Title *Preferred Mailing Address *BusinessHomeAre You Married? *YesNoIf married, what is your Anniversary date?MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Spouse/Partner NameFirstLastSpouse Nickname or Preferred NameIs your Spouse/Partner a current Rotarian?YesNoClub NumberClub NameCityStateDate JoinedMM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY202720262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Have you ever been a member of a Rotary Club? *YesNoIf Yes, list Rotary Club Name(s) and Dates *If you answered "Yes", list all Rotary Clubs you have been a member of and the dates you were a member. If you answered "No", enter N/A.LIST CLUBS OR SERVICE ORGANIZATIONS YOU HAVE PARTICIPATED IN AND ANY ACHIEVEMENTS OR OFFICES HELD AND WHEN (Enter N/A if it does not apply) *List any type of clubs or service organization you have been a member of with the Offices/Years and any achievements in each club. Enter N/A if you have not ever been a member of a club or service organization.DEGREES - Please list your degrees (and area of study/specialization) if any or None if you don't have any. (Example: Associate in Arts Degree, Bachelor of Science in Computer Science, etc.) *Please list what degrees you may have and the area of study/specialization.HOBBIES & INTERESTS: i.e. sports, reading, etc. *Please list what interests you have and any hobbies you enjoy.COMMUNITY LEADERSHIP & OTHER COMMENTS. *Are you involved in community organizations (board member, volunteer, etc.) projects, outside organizations. Please tell us about your involvement including any leadership positions held. Why do you want to join Rotary? *What interested you in wanting to join our Club/Rotary?How do you want to be involved in our Club? Rotary is a service-driven organization. Based on our current initiatives and projects listed on our website https://www-claytonrotaryclub-org-stg.wordifysites.com please indicate how you would be interested in getting involved: I am interested in: *Community Service ProjectsYouth & Education ProgramsFundraising EventsLocal Partnerships & OutreachInternational Service ProjectsClub Leadership / CommitteesEvent Planning & CoordinationFlags For HeroesLeigh Hudson Golf TournamentSalvation Army Bell RingingOther: (Please describe below)Choose as many items above that interest you. If you chose "other", please describe below.Other Interest:Please describe what else you are interested in that wasn't listed above.Skills or Expertise You Would Like to Contribute: *What skills or expertise would you like to share with our Club?Availability / Preferred Level of Involvement *Monthly ParticipationQuarterly ProjectsSpecial Events OnlyOpen to Any OpportunitiesHow involved do you want to be/are available to be in Rotary/Our Club?Are You Interested in Leading or Co-Leading a Project? *YesNoMaybe in The FutureWhat is your interest in being in charge of a project in our Club?Have you attended one or more meetings at our Club? *YesNoEnter Dates of Meetings You Have Attended *Your Photo - Headshot only * Drag & Drop Files, Choose Files to Upload FOR ONLINE APPLICATIONS: Please upload a headshot of you in .jpeg or .png format. This will be posted on our Club website on the Members' page if you are approved. FOR OFFLINE APPLICATIONS: Please give to your sponsor or the membership chair at the sign-in table by the door, or email the file to: rotaryclubclayton@gmail.com PHOTO REQUIREMENTS: Only headshots. No other people, animals, businesses, or advertising in the photo. Make sure the photo is clear-no dark or blurry images. Please make sure the background is simple.Submit Save and Resume Later Your form entry has been saved and a unique link has been created which you can access to resume this form. Enter your email address to receive the link via email. Alternatively, you can copy and save the link below. Please note, this link should not be shared and will expire in 30 days, afterwards your form entry will be deleted. Copy Link Email * Send Link