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Los Altos Rotary Club

Home of the Annual Rotary Fine Art Show
rev 08/16/09

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:
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:

          

06/24/09

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