EIB Nomination Form – Rotary Club of Golden

Name*
First Last
Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Personal Email*
Personal Phone*
Name of Business
Business Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Title
Classification
Business Phone
Fax
Birthday*
MM slash DD slash YYYY
Former Rotarian
Spouse Name
First Last
Wedding Anniversary
MM slash DD slash YYYY
ACTIVITIES/INTERESTS WHICH WOULD RECOMMEND OUR CONSIDERATION OF YOU TO BE A GOLDEN ROTARIAN:
Sponsoring Rotarian
I understand that it will be my duty, if elected, to exemplify the Object of Rotary in all my daily contacts and activities and to abide by the constitutional documents of Rotary International and the Rotary Club of Golden, CO. I agree to pay an admission fee of $65.00 with my application and dues of $225.00 per quarter, and give my permission to the Club to publish my name and proposed classification to its membership. Enter your full name below.*

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