Application For Membership To Rotary E-Club of District 9650 Inc
| Name of Applicant | |
| Address of Applicant | |
| Date of Birth | |
| Mobile Phone Number | |
| Email Address | |
| Partner’s Name | |
| Partner’s Date of Birth | |
| Name of Former Club (If former Rotarian) | |
| Former Club – Email | |
| Former Club – Phone No | |
| RI ID Number | |
| Classification | |
| Applicant’s Signature | |
| Sponsor’s Name | |
| Sponsor’s Signature | |
| Date |
Bank Details – E-Club of District 9650 Inc; BSB 032-621
Account No. 790814.
(Include name of payee and applicant’s name when making payment)
Official Use by Rotary E-Club of D9650 Secretary:
| Date Received | |
| Date Approved | |
| Date of Joining | |
| Amount Paid | |
| Date Paid |