Membership Application

Membership in Rotary Club is by invitation, and it is mandatory to have two seconders and one sponsor to submit your application. However, if you would like to become a member of the club, please fill out the application form below. We look forward to meeting and getting to know through the application process and beyond.

Note: Regular membership is available to the Rotarians who are of Age 35 and over

General Information

Fields marked with * are required.

Your Name*:

Date of Birth*:

Birth City/State*:

Home Address*:




Primary Telephone Number*:

Preferred Email*:

Business Information

Business Name*

Business Address*:




Business Telephone*:

Business Email:

Business Website:

Describe the type of business in which your firm engages.*

What do you hope to get out of your Rotary membership and which committees are you interested in joining?*

To what organizations do you belong? (Professional, Civic, Social, Charitable)*

Are you a current/former member of any other Rotary Club?*

Glendale Rotary Noon members are business and civic leaders. But they also enjoy time outside work. Can you tell us more about your family, life, interests, hobbies, and weekend activities?*

Undergraduate Affiliation & Degrees*

Undergraduate Affiliation & Degrees*

Military Service/Rank

Foreign Languages Spoken

Musical Instruments Played

Public Offices Held