New Member Application for Rotary Club of Fishers, Indiana

New Member Application

Thank you for your interest to join the Rotary Club of Fishers, Indiana. Please complete the application below. The application is for review by the Rotary Club of Fishers, Indiana. The information below will be included in the club directory and will remain confidential to club members and Rotary International.
Your Name *

First Name Last Name
Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Cell Phone Number *

Area Code Phone Number
Home Phone Number: *

Area Code Phone Number
E-mail *
Birth Date: *

Month Day Year
Employer *
Occupation *
Work Address:

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Work Phone Number

Area Code Phone Number
Sponsoring Rotarian *

First Name Last Name
Past Rotary Membership? If yes, please indicate which club. *
Current and Past Community Involvement or Volunteering:
Have you participated in any previous Rotary activities? Please include dates if possible.
Classifications *
If you select other please list classification type
Education History:
Please indicate preferred location for Rotarian Magazine delivery. *

Home Office
Languages spoken/read:
Upload a Professional Headshot *

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Cancel of
I understand that if accepted for membership, it will be my duty to exemplify the Object of Rotary in all my daily contacts and activities and to abide by the constitutional documents of Rotary International and the Rotary Club of Fishers, Indiana. I agree to pay an administrative fee of $50 (due at time of application) and the dues of $100 payable twice annually in accordance with the bylaws of the club. I hereby give my permission to the club to publish my name and proposed classification to its membership. *

I have read, understood, and accepted the rules for membership.
Application Fee of $50.00 to be mailed to Fishers Rotary Club, c/o Mike Peterson, 11445 Lake Stonebridge Lane, Fishers, IN 46037 or submitted to Club Treasurer at the next Rotary Club Meeting.
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New Member Application

Application Fee of $50.00 to be mailed to Fishers Rotary Club, c/o Mike Peterson, 11445 Lake Stonebridge Lane, Fishers, IN 46037 or submitted to Club Treasurer at the next Rotary Club Meeting.