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Los Altos Rotary Club

Home of the Annual Rotary Fine Art Show

Membership Application Form
And Handbook Information

Providing this information does not in any way obligate you or the Rotary Club of Los Altos concerning membership.

PERSONAL INFORMATION:

First Name:
Last Name:
Nickname:
Date of Birth:
Birthplace:
Classification:
Shirt Size: Extra Small Small Medium Large 1x Large 2x Large 3x Large
Sponsor:
Residence Address:
Residence City:
Residence Zip:
Residence Phone:
How long at this address?:
How long in area (in Years):
Preferred Email:
Organizations:
Hobbies/Avocations:
Military Service:
Previous Rotary Service (year joined, club, offices held:
SPOUSE'S INFORMATION
Spouse's Name:
Anniversary:
Children (names):
EDUCATION
Highest Education Degree:
Institution:
BUSINESS INFORMATION:
Profession or Business:
Business Address:
Business City:
Business ZIP:
Business Phone:
Business Email:
Position:
How Long in current business/profession?:
PERSONAL AND BUSINESS REFERENCES: Please provide two personal and business references. Include Area Codes for phone numbers.
Personal Reference #1 Name:
Personal Reference #1 Phone:
Personal Reference #2 Name:
Personal Reference #2 Phone:
Business Reference #1 Name:
Business Reference #1 Phone:
Business Reference #2 Name:
Business Reference #2 Phone:
Autobiographical Sketch: