New Member Form

Meetings: 12:10 pm on Mondays @ The Confluence – 214 East Washington Street – New Castle, PA

If you are interested in becoming a Rotarian, please complete this form. Someone will contact shortly.

Name

Nickname

Home Address

Email Address

Preferred Phone Number

Phone Type

Home Cell

Employer

Occupation/Title

Business Address

Business Phone

Military Service/Branch

Preferred Method of Contact

Home Phone Business Phone Call Cell Text Cell Email

Spouse/Partner Name

Rotarian Sponsor