I, the undersigned, being familiar with the requirements for and conditions of membership, hereby make application for:

I understand that it will be my duty, if elected, to exemplify the Object of Rotary in all my daily contacts and activities, additionally I promise to abide by the constitution and by-laws of the club. I understand that part of my membership dues will provide me an annual subscription to the Rotarian magazine or an approved and prescribed regional magazine. I agree to pay the admission fee of $100.00, the annual dues of $400.00, and annual Meal cost of $464.00 billed bi-monthly ($144 bi-monthly for both dues and meals), by automatic deduction from my checking account, by credit card deduction (plus a 4% fee), in accordance with the by-laws of the Club. I hereby give my permission to the Club to publish my name and proposed classification to its members.