St Paul Rotary Membership Form

Welcome! Thank you for being interested in St Paul Rotary. We are eager to add your skills, energy and perspective to the club's rich history of service, leadership, and philanthropy.

Your member dues provide the infrastructure to undertake local and global service projects, provide top inspirational and informational speakers and fellowship networking events, as well as cover the operational costs of your membership. Your tax-deductible contribution creates impact here and around the world by funding our charitable initiatives.

We are so excited to have you join St Paul Rotary's “people of action” making a difference at home and around the globe.

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Preferred Phone Number *

Preferred Email Address for Member Communication *

Organization

Title/Position

Type of Business *

Date of Birth *

Spouse/Partner

Membership Categories - updated 11/30/2021

Signature
--Membership for one individual

Corporate
--Includes membership for up to two representatives from your organization (A third may be added for an additional fee)

Duo
--Includes membership for two individuals living in the same household

Flex
--Members pay additional $25 for each lunch attended.

Note: If membership is accepted, 30-day written notice is required for membership termination.

Membership Category *

Tax-Deductible Contribution
In addition to my Club dues, I would like to further our mission and make a local impact on the community with my donation to the Saint Paul Rotary Foundation

Make this contribution

Monthly

Annually

One Time

Total

$0.00

Name of 2nd Corporate/Duo representative:

Corporate/Duo 2nd Representative Cell Phone Number:

Corporate/Duo 2nd Representative Email Address:

Names of nominator/sponsor

Former Rotarian? Please let us know the club(s) you have been involved with *

I hereby certify that I am qualified for active membership in the Rotary Club of Saint Paul (“the Club”) by my current or retired status as a business or community leader, and by having a place of business or residence within the Club’s locality or surrounding area. I give permission to the club to publish my name and proposed classification to its membership. *

Yes

If accepted for membership: It will be my duty to exemplify the Object of Rotary in all my daily contacts and activities and abide by the Club’s constitution and bylaws. I agree to pay all my bills according to the Membership Billing Policy, including an admission fee and monthly dues, and understand that the Club makes use of automatic payments. I hereby authorize the Club to initiate debit entries to my bank (or other financial institution) account specified below. This authorization will remain in effect until the Club is notified by me in writing to cancel it in time so the Club is afforded a reasonable opportunity to act on it. *

Yes

Payment Information

St Paul Rotary charges dues automatically once per month* on the 15th. Charging dues directly to your checking account is the most secure option. This option also avoids transaction fees for the club, which means 100% of your dues payments go to cover membership expenses. You may also choose to have your dues charged to a credit card.

*Business/Organization members may choose the annual pre-payment option.

For billing purposes... *

Use the address and contact information entered above

My Rotary invoices should go to a different address/billing contact

Contact Person for Billing Purposes (for Business/Organization Memberships)

Billing Contact First Name

Billing Contact Last Name

Billing Street Address

Billing Address Line 2

Billing City

Billing State

Billing Zip Code

Billing Phone Number

Billing Contact Email Address

My business/organization will pre-pay dues annually and requires an invoice to generate a payment by check. Rotary dues payments may all be mailed to: PO Box 600065 Saint Paul, MN 55106 Phone (651) 222-2028

Yes

To charge your dues to a bank account

Your Bank

Type of Account

Account Number

9-digit routing number

To charge your dues to a credit card

Name on Card

Credit Card Type

Credit Card Number

Expiration Date (mm/yy)

CVV / Security Code

Gov. Elmer L. Andersen Fellowship $1,000	President's Circle $500
Benefactor $250	$100
$75	$50
$25	$10