Schenectady Rotary - Membership Application
Applications are reviewed by the Board of Directors on the 2nd Wednesday of each month. Application fee must be received prior to review.

Prospective members are encouraged to visit the club several times prior to application review.  A one-on-one introduction is also encouraged.  Contact SchenectadyRotaryClub@gmail.com for more information.

Meetings are every Thursday from Noon - 1pm.  Join in-person at Turf Tavern in Scotia (Lunch $18) or via Zoom at https://us02web.zoom.us/j/667032763?pwd=MVpma0gyMHhYT1NCVndQeXpIY084dz09.

(This information will be used for the your induction and the Rotary International Roster)
Email *
Full Name *
Nickname or Preferred Name
Home Address (Street, City, State, Zip) *
Home Phone
Cell Phone (at least 1 phone number required)
Employer
Work Address (Street, City, State, Zip)
Work Phone
Job Title/Responsibility
Birth Place
Date of Birth
MM
/
DD
/
YYYY
School(s) Attended/Degrees Received/Dates
Spouse's Name (if applicable)
Spouse's Nickname
Names/Ages of Children (if applicable)
Special Interests, Hobbies, Sports
Community Activities
Awards/Honors
What attracts you most about Rotary? *
Other information you would like to share:
Have you served in Rotary before, if so, where/when?
Rotary Positions held (if former/current member)
Sponsor's Name
Business Reference (Name/Contact Information)
Personal Reference (Name/Contact Information)
I understand that the Rotary of Club of Schenectady is a dues paying organization and that I will be billed twice per year for the dues.  (Currently $100 per 6-month billing cycle, will be $105 beginning in January 2024) *
To help you get a better sense of the membership experience, you are encouraged to participate in club activities four times prior to application review.  This can include any combination of club meetings, social events, service projects, or committee meetings. 

Please list the dates of attendances and the types of event below.
 *
I will submit a $50 application fee to the Schenectady Rotary Club either via check (mail to: Schenectady Rotary Club, PO Box 346, Schenectady, NY 12301) or via PayPal:  https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=LTNNP5SAXX3HE *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms