New Member Application Form Fields marked with an * are required Introduction Thank you for completing an application for membership with the Rotary Club of Waupaca. Note that each individual seeking to be a member under a corporate or family membership must complete an application. First Name * Last Name * Partner's Name Married? * Yes No If Married, Anniversary Date Children - Names and Ages Address (Street, City, State, Zip) * Phone * Email * Professional Status * Working Retired Company/Employer (Most recent if retired) * Occupation (Most recent if retired) * Business Address Business Phone Date of Birth (mm/dd/yyyy) * Previous Rotary Club Member? * Yes No Prior Rotary Clubs, Positions, and Achievements (if applicable) Interests and Hobbies * Skills and Experience You Bring to Rotary * Name of Your Sponsor * Submitted by - Type Your Name * If you are a human seeing this field, please leave it empty.
