Service Above Self

Rotary Club of Youngsville

Membership Application

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Welcome

Ready to make a difference?

We’re a fun, engaged group of service-minded neighbors working together to strengthen Youngsville and communities beyond. Complete this application to begin the membership process.

* Required field

About you

First nameMiddle initialLast namePreferred nameName for your badgeBirthdateGender

Contact information

Email addressCell phoneHome phoneOffice phoneSponsor 1Sponsor 2

Addresses

Home address

Street addressSuite, unit, or buildingCityStateParish / CountyPostal code

Business address

Street addressSuite, unit, or buildingCityStateParish / CountyPostal code

Preferred mailing address * Home Business

Professional information

Company / OrganizationJob title / OccupationWebsiteFax number

Spouse or partner

Optional

First nameMiddle initialLast nameSuffixPreferred nameAnniversary

Is your spouse or partner a Rotarian? Yes No

Rotary history

Rotary ID numberPrevious club nameCity / StateDate joinedDate resignedAdditional previous clubCity / StateDates of membership

Club participation and achievementsInclude offices held and the year, if applicable.

Help us get to know you

Personal and professional bioDegrees, certifications, or credentialsHobbies and interests

Finish

Submit your application

Your information will be shared only with club leaders involved in membership review and administration.