Membership Application

Name*
First Last
Address*
Street Address City State / Province / Region ZIP / Postal Code
Email*
Phone*
Date of Birth*
MM slash DD slash YYYY
Employer
Have you been a Rotarian before?*
- Yes
- No
What is your Rotary Member Number
Club Participation:
Attended a Club Meeting
MM slash DD slash YYYY
Attended a Club Meeting
MM slash DD slash YYYY
Attended a Club Meeting
MM slash DD slash YYYY
Attended a Club Fun Night
MM slash DD slash YYYY
Participated in a Service Project
MM slash DD slash YYYY
I hereby certify that I am qualified for active membership as a member of the Oklahoma City community. I understand that, if accepted for membership, it will be my duty to exemplify the Object of Rotary and Rotary's Four Way Test in all my daily contacts and activities and to abide by the constitutional documents of Rotary International and the Oklahoma City Midtown Rotary Club. I agree to pay a required $50.00 new member admission fee and to pay quarterly dues of $100.00 in accordance with club bylaws. I hereby give permission to the club to publish my name and proposed classification, if applicable, to its membership.*
- I AGREE