Membership Application Form

First Name

Middle Name

Family Name

Date of Birth

Gender

Male

Female

Marital Status

Married

Unmarried

Are you a former Rotarian or Current member of another Rotary club?

Yes

Were you Rotary alumnus/ alumnae?

Yes

Home Address

Preferred Phone Number

Country

Postcode

Alternate Phone Number

Preferred mailing address

Residence

Business

Others

Alternate Address

Add More

Job Title

Name of Business or Organization

Classification

Business Address

Business Telephone

Fax

Business Email

(I hereby certify that if accepted to membership of the Rotary club of Himalayan golfers that I as a Rotarian will exemplify the object of rotary in all my daily contacts and will abide by the constitutional document of rotary international and the club. I agree to pay an admission fee and dues in accordance with the by law of the club)