Organization/Sponsor Registration

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We, _______________________________, apply for Corporate Membership with the Brick City Rotary Club of Newark NJ and authorize consideration by the Club’s Board of Directors. If approved by the Board, we authorize publication of our organization’s name and (will provide 2 corporate / organization) designees to the Club’s membership roster. We further agree to abide by the requirements of Rotary membership and to pay the Club’s standard Corporate Membership annual dues within the timeframe prescribed by the club.
(Applicants need to choose a rotary committee of interest & requirements)

Name of Organization *

Corporation or Business Information

Corporate Name *

Corporate/Business Address *

City

State/Province

ZIP / Postal Code

Country

Business Telephone Number *

Business Website

Image UploadPlease upload your Corporate/Organization Logo for our partners records.

No file chosen

Primary Corporate Designee Information

Name *

Title *

Birthday *

Home Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Preferred Phone Number *

Preferred Email Address *

Community Involvement *

Personal Interests *

Are you a past Rotary member *YesNo

Rotary Club Name *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Year/Dates of Membership *

Alternate Corporate Designee(s)

How many alternate designees do you want to add? *The Corporation has the option of naming up to three (3) Alternates who would maintain representation of the Corporation at various Club functions and activities when the Primary Designee is unable to participate.123

Alternate Designee 1

Name *

Job Title *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone *

Email Address *

Alternate Designee 2

Name *

Job Title *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone *

Email Address *

Alternate Designee 3

Name *

Job Title *

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Phone *

Email Address *

NOTE: Alternates are not official members of the Rotary Club of Newark, NJ, and therefore not eligible to hold Club office. Alternates may participate in any other Rotary Club events and activities, either as a representative of the Primary Designee or on their own, if they so choose.

Do you want to enroll in Magazine Newsletter? *

How would you like to receive the magazine? *DigitalPhysical

Membership Agreement

Prospective members agree to:

Service – Rotary’s motto is Service Above Self. Members are willing to participate in undertaking service projects that improve the lives of people in the community and/or around the world.

Engagement/Participation – Each member is asked to attend club meetings for fellowship and information, to get involved with club activities, club social events and fund-raising endeavors, to be a member of a committee(s) of their choice, and to participate in local service projects.

Financial Support – The Corporation is responsible in paying for the annual Corporate membership fee of $320.00 payable following induction into membership and by June of each year, meal cost when attending club meeting(s), fundraising tickets, etc. Each Corporation is encouraged to support The Rotary Foundation that helps Rotarians continue Doing Good in the World by making an annual donation of $100.00.

Corporate Primary Designee Signature *

Date *

Sponsor Signature *

Date *

Date of Orientation/Rotary Info Meeting *

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