EmailMe Form - Information request form

Name *

Email *

Use of personal email strongly encouraged. Reliance on business email can result in issues due to business policies.

Phone Number *

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How would you like us to contact you?

email

telephone

Home Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

What city or town do you work in? *

Business name *

Professional Title/Occupation *

Are you familiar with Rotary and it's activities

Yes

No

Why are you interested in joining our club?

Leave a comment or ask a question about the Rotary Club of South Portland-Cape Elizabeth:

If you were previously a Rotarian, or are interested in tranferring clubs, please fill in the following information.

When did you first join Rotary?

MM / DD / YYYY

When were you last a member?

MM / DD / YYYY

Club name

Club location

Rotary number

Please enter Rotary positions, designations, or any other
information about your Rotary experience you'd like us to know.