Fillable R CoV Membership Application Fillable Form 2021 Portrait (Microsoft)

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R CoV Membership Application Fillable Form 2021 Portrait (Microsoft)

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MEMBER APPLICATION FORM
Page 2 | 5
Please fill out the membership application form completely and include: a c urrent resume or biography,
and a head-shot photo. Applications can be submitted by email to admin@rotaryvancouver.org.
For couple, corporate and family memberships, one form per individual applicant is required.
Personal Information
Last Name First Name Nickname Date of Birth
Spouse Last Name Spo
use First Name Nickname Date of Anniversary
Home Suite # - Stree
t Address City Postal Code
Home Phone Personal Cel
l Phone Home Email Address
Professional Information
Business/Organi
zation Name
What Product/S
ervice does your Business/Organization provide?
Business Suite # -
Street Address City Postal Code
Business Cell
Phone Business Email Business Phone
Current Position/J
ob Title Briefly describe your current role in your business or organization
Financial interest in Company? ☐ NONE ☐ MODERATE ☐ SUBSTANTIAL
Years at Current Company/Org.: ___________________
University/C
ollege Degree(s)
Prior Business
/Organization Name Position
Preferred
Contact Method
:
Email: ☐ Personal ☐ Business Mail: ☐ Personal ☐ Business
Phone: ☐ Cell ☐ Business ☐ Home
Page 3 | 5
Professional or Personal References
List the names of at least two (2) members of the business and professional community with whom you are well
acquainted and who can speak to your potential membership in the Rotary Club of Vancouver. Please indicate
the number of years you have known each, their email address and phone number. These references are in
addition to your Proposer and Seconder.
Note: Please notify all references that a member of the Classification Committee will contact them.
1) _________________________________________________________________________________________________
Rotarian or Reference Name Yrs Acquainted Phone Email Address
2) _________________________________________________________________________________________________
Rotarian or Reference Name Yrs Acquainted Phone Email Address
Community Service Information
Please list recent, if any, community service activities:
_________________________________________________________________________________________________
Organization Name Position From (yy/mm) To (yy/mm)
_________________________________________________________________________________________________
Organization Name Position From (yy/mm) To (yy/mm)
_________________________________________________________________________________________________
Organization Name Position From (yy/mm) To (yy/mm)
Membership Type
The Rotary Club of Vancouver offers eight (8) membership categories. Please indicate which membership type(s)
you are applying for:
Regular Member (age 41-65) Couples (all ages)
Senior Member (age 65+) Corporate Member with 3 members
Young Leader (under age 40) Corporate Member with 2 members
Young Professionals Division (under age 40) Family Member
Financial Obligations of Membership
The fees shown on the insert are a requirement of membership. The initiation fee, pro-rated dues and meal
charges will be billed upon acceptance. Fees are paid quarterly, with the Rotary year beginning in July. Fees are
reviewed regularly and are subject to change periodically without notice.
Receipts, Invoices, & statements are sent by email to the Member. Payments are processed using payment
information on file. Please let us know if you’d like us to cc anyone on your billing emails:
_______________________________________ _______________________________________________
Name Email
_______________________________________ _______________________________________________
Name Email
Page 4 | 5
Prior Rotary Membership (if applicable)
Name of Rotary Club From (mm/yy) To (mm/yy)
RI Number
Reason for Leaving
Membership Classification
Classifications help members find other members in their own industry, or in a field where they are looking for
services through our online membership directory. They are a great tool for building your professional network
within Rotary. Please choose a classification from the options below. You may then add up to 3 words to the end
to make it more specific to the products or services you offer. For example, “Banking—Small Business Lending”
or “Banking—Commercial”. The classification is subject to acceptance by the Membership Committee’s
Classification team.
Suggested Classification:
_____________________________________________________________________________
Accounting
Consulting
Health Care
Non-Profit
Advertising Construction Honorary Public Relations
Aerospace & Defense Contracting Hospitality Real Estate
Agriculture Distribution Insurance Retail
Architecture
Education
Investments
Retired
Associations & Clubs Energy Law Practice Sales & Marketing
Automotive Engineering Legal Services Technology
Banking
Financial Services
Manufacturing
Telecommunications
Business Services
Foundations & Institutions
Marketing & Sales
Transportation
Terms of Membership
I, the Applicant, if approved as a member, understand that 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
club. I agree to pay any admission fees required by the club and to pay fees & dues in accordance with the club
bylaws. I understand that I will be expected to serve on at least one Rotary committee, attend its meetings
regularly and engage in its activities.
If the application is approved, the candidate will be welcomed to membership. This process may take several
weeks; the Applicant is invited to attend weekly meetings as a guest during that time.
I consent to the collection, storage, and use of my information by Rotary Club of Vancouver as described in the
Club’s Privacy Policy. I hereby give permission to the club to publish my name and proposed classification to its
membership. I understand that I may receive emails and can opt out at any time. A notification email will be
sent to me the first time my contact information is stored.
I, the Applicant, have read and understand the application, including the membership expectations and the
required amount of dues and fees.
Applicant Signature ________________________________________ Date (yyyy/mm/dd) _______________
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Page 5 | 5
To be Completed by the Proposer/Sponsor:
I believe this candidate to be:
1)
Fully informed of the requirements of Rotary membership.
2)
Associated with a company/organization regarded as ethical, and is
3)
In a position that enables him/her to exercise influence over the operations of their
position/company/organization.
Sponsor Name: ___________________________________________________________________________
Sponsor Signature: ________________________________________________________________________
Sponsor has known the candidate for:
____/____Years/Months
Seconder Name: __________________________________________________________________________
Seconder Signature: _______________________________________________________________________
Seconder has
known the candidate for: ____/____Years/Months
Recommended classification: _________________________________________________________________
Further
c
omments:
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Membership Dues (updated October 2021)
Welcome!
You can join the Rotary Club of Vancouver in one of eight (8) membership categories:
•
Regular member
•
Senior member (over age 65)
•
Young Leader (under age 40)
•
Young Professionals Division (under age 40)
•
Couple
•
Corporate member with 3 members
•
Corporate member with 2 members
•
Family member
Membe
rship fees differ per category. A one-time initiation fee is also applicable. The Rotary Club of Vancouver Fee
Structure is as follows:
* Plus GST
† Additional charges may apply based on frequency of attendance and number of corporate or family
members participating in club luncheons. The quarterly meal charges include 12 lunches for that quarter;
each lunch beyond 12 will be charged on a cost recovery basis, currently $52.00 per person (tax included).
Individual couple, corporate representative, and family members can, on or before July 1, October 1,
January 1 and/or April 1, elect to pay the quarterly meal charges of $350 for the subsequent quarter. If they
do, meals eaten by them shall not be counted in the limit of 12 for that quarter for the couple, corporate or
family membership. Additionally, if such a choice reduces the representative corporate or family
membership to one person, after excluding representatives who have elected to pay quarterly meal charges
on an individual basis, the quarterly meal charge for the remaining corporate or family member will be
reduced from $565 to $350.
Members over the age of 65 receive a 10% discount on their dues. Individual members under 40 receive a 40%
discount on their dues.
Guests are always welcome! The guest/visiting Rotarian rate is $52.00 (tax included), payable at the door.
We encourage Rotarians to make up missed meetings at other clubs. For each official make-up card you submit from
another club (indicating you attended a regular meal meeting of that club), you will receive a $15 refund, paid out at
the end of the fiscal year.
Though all members are encouraged to attend the weekly regular meetings, we acknowledge in some
circumstances this isn’t possible. Therefore, the Board will consider written requests to register as a “pay-as-you-
go” for meals in special circumstances. Young Professional Division members are on “pay-as-you-go” for meals.
For more information, please contact our Membership Committee Chairs, Franz Gehriger fgehriger@swissreal.com
.
P.O. Box 48358 Bentall, Vancouver, BC V7X 1A1 ● admin@rotaryvancouver.org
One-time
initiation fee*
Quarterly
Standard Dues*
Quarterly
Meal Charges*
TOTAL
Quarterly Fees
$350
$180
$350
$530.00 + GST
$350
$162
$350
$512.00 + GST
$350
$108
$350
$458.00 + GST
waived
$108
$108.00 + GST
$350
$180
$350
$530.00 + GST
$350
$180
$700
$880.00 + GST
$1,000
$349
$565
$914.00 + GST
$700
$295
$565
$860.00 + GST
$700
$349
$565
$914.00 + GST
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R CoV Membership Application Fillable Form 2021 Portrait (Microsoft)

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Completed 25 March 2022

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