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UCLA Rotaract Membership Application for 2008-2009

Name: Email: Phone Number: Year in School: Major: Birthday (MM/DD/YY): Other extracurricular activities/jobs/organizations:

Why do you want to join Rotaract? (i.e. leadership development, community service, social)

How did you hear about our club? How many hours a month can you dedicate to our Rotaract Club?

Membership is a yearly $10 fee, which includes a Rotaract Pin. I understand and accept the principles of Rotaract as expressed in its purpose and objectives, and agree to comply with and be bound by the Standard UCLA Rotaract Club Constitution. Signature: Date:

Welcome to the Rotaract Club at UCLA!


Thanks for helping make this an unforgettable year! Feel free to write your questions or comments on the back of this form.

For official use only: PAID: $______ Cash / Check Date: _____________________ _________ Last Name Initial:

UCLA Rotaract Membership Application for 2008-2009

For official use only: PAID: $______ Cash / Check Date: _____________________ _________ Last Name Initial:

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