Prospective Member Form – Rotary Club of Madison

Prospective Member

Thank you for your interest in becoming a Rotarian. The Rotary Club of Madison is one of the ten largest of over 46,000 clubs in the world. We are an active and engaged club. Our members’ volunteerism, fundraising and fellowship affect the quality of life in the community. We’re a group of business, professional and community leaders dedicated to making a difference locally and around the globe.
Our universal premise is that each club’s membership constitutes an accurate representation of the business and professional population within the community served. Membership in our club requires an invitation and sponsorship by a member of the club. Membership may be limited by openings within your particular business or professional classification. Sometimes an individual cannot be invited or sponsored for membership. For more details, about eligibility and membership information, review our Rotary Club of Madison Brochure.
If you are a leader in your organization, you should belong to the Rotary Club of Madison. Complete this form to let us know you are interested.

First Name

Last Name

Name of Organization

Position with Organization

Business Phone Number

Email Address

I have read the membership criteria, and I meet the qualification for membership.

Yes

Have you previously been a Rotary member?

Yes

If yes, list city, state, and years of membership:

Previous City

Previous State

Number of Years

Have you been a member of another service club?

Yes

If yes, list name of club and years of membership:

Past Club Name

Years in Past Club

Do you know any current Rotarians? If so, please list here:

How did you hear about our Rotary Club? (such as friend, co-worker, mailing, media, etc.):