New Member Proposal for Rotary Club of Castle Hill

Send proposal to * 🛈

Secretary

President

Webmaster

Nominator's details

First Name *

Last Name *

Phone Number *

Email Address *

Nomination date +

Check to indicate Nominee's permission is granted as above, and Nominee is over the age of 18

* 🛈

Title

Nominee's First Name *

Middle Name(s) or Initial(s)

Nominee's Last Name *

Phone Number *

Fax (if applicable)

Gender * 🛈

Email Address *

Rotary membership ID (if applicable)

Recent Rotarian for one year or less?

Street Address *

Address Line 2

City *

State *

Post Code *

Country

Nominee's current status *

New to Rotary	Participant of a Rotary Program (current or former)
Currently a member of another Rotary Club	Former member of a Rotary Club

Other or former Club name (if applicable)

From +

To +

Current or former profession *

Employer

Proposed Classification for this club *

Nominee is or was a (check all that apply, if any) 🛈

Previously held or current Rotary positions (if applicable)

Additional supporting information? 🛈

Optional Attachment 🛈

Interactor	Rotaractor
Youth Exchange Student	Ambassadorial Scholar
Rotary Peace Fellow	GSE Team Member
RYLA participant	Other (please specify) Other (please specify)