Inscription – Club Mustang Mauricie

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Formulaire d'inscription

Nom

First

Last

Date de naissance (mm/dd/yyyy) *

Adresse courriel *

Telephone *

Comment préférez-vous être contacté ? (Sélectionnez tout ce qui s'applique) *

Courriel
Téléphone
SMS
Facebook (Messenger)

Adresse *

Address Line 1

City

State / Province / Region

Postal Code

Country

Where do you work?

What is your role there?

Rotary & You

This section will help us learn a bit more about your interest in Rotary.

How did you hear about us? (Select all that apply) *

From a current or past member
Attended a fundraising event in the community
Worked with Rotary for a service project
Search engine results while researching volunteer/community organizations
Website
Social Media
I am Rotary alumni
Other

Other (please specify):

Name of the person who referred you

Name and date of event

Location and date of service project

Which social media profiles?

Facebook
Instagram
LinkedIn
YouTube

To which Rotary programs did you belong or participate?

Interact Club
Rotaract Club
Rotary Youth Exchange
Other

Other (please specify)

Which of Rotary's areas of focus interest you most? (Select all that apply)

Peacebuilding and Conflict Prevention
Disease Prevention and Treatment
Water, Sanitation, and Hygiene
Maternal and Child Health
Basic Education and Literacy
Community Economic Development
Environment

Preferences

Please share your Rotary preferences to help us ensure the best fit.

Why are you interested in joining Rotary? (Select all that apply)

To become more embedded in my community
Local community service opportunities
Global service opportunities
To network for business
To make new friends
Professional skill building and leadership opportunities
Travel opportunities
Other

Other (please specify):

Rotary operates through members volunteering their skills. How are you able to help?

Social media
PR and public image
Planning events
Managing budgets and funds
Technology
Graphic design
Maintaining websites
Other

Other (please specify):

Our club meets Thursday mornings at 7:30 a.m. at the local library. Does this work with your schedule? *

Always
Most of the time
Sometimes
Never

If this meeting time isn't the best for you, we can help you find a better fit with another club. Which days are good for you?

Monday
Tuesday
Wednesday
Thursday
Friday

What time of day is your meeting preference?

Morning
Afternoon
Evening

Agreement *

I agree to the terms below.

I understand that if my application is accepted, I will be expected to participate regularly and pay annual dues.

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Name *

First

Last

Name *

First

Last