Please complete this form as thoroughly and legibly as possible. Your proposer and reference must also complete and submit the attached Proposer/Reference form. Attach payment of the admission fee and dues in accordance with the schedule below. Upon receipt of these forms, the Club Administrator will review your application and assign a classification. The Board will then evaluate the application and take action, followed by presentation of your name to the membership for final approval. If approved, you will be contacted to arrange for your official introduction. Your payment will be deposited after your application has been approved for membership. Applications and Proposer/Reference must be completed in order to be considered.

Personal Information
*REQUIRED
*REQUIRED
Organization Information:

I, the undersigned, being familiar with the requirements for, and conditions of membership as explained on the attachment to this application and contained in the constitution and bylaws, hereby make application for Active Member of Lincoln Rotary Club #14. I understand that it will be my duty, if elected, to exemplify the Object of Rotary in all my daily contacts and activities, and, at all times, to abide by the constitution and bylaws of the Rotary club. If my actions, either prior to application, or in the future, are inconsistent with these obligations, I agree to resign my membership upon request of the Rotary Club #14 Board. I hereby submit the Admission Fee and the Annual Dues indicated below in accordance with the bylaws of the club. I give my permission to the club to publish to its members my name and proposed classification.

*REQUIRED
*REQUIRED