Rotary Club of Middlebury, Vermont
Corporate Membership Application
 
 
We apply for corporate membership in the Rotary Club of Middlebury, VT, and authorize our consideration by the Board of Directors. If approved, we authorize publication of our organization’s name and representing designees to the Middlebury Rotary members for consideration by the club membership. We agree to abide by the requirements of membership and to pay the annual dues promptly.  We understand that we may have up to four designees.
 
Company or Firm Name: _________________________________________________________
Business Address: ______________________________________________________________
City/State/Zip: _________________________ Website Address: _________________________
Classification (Type of business): __________________________________________________
 
Company Designee 1
                                           *Please mark an asterisk * next to preferred email address for Rotary correspondence
Name: _____________________________ Title: _____________________________________
Business Phone: _______________Fax: ________________ E-mail: ______________________
Business Adress:________________________________________________________________
Home Address: _________________________________________________________________
Home City/State/Zip: ______________________Home Phone: __________________________
Home E-mail: __________________________________________________________________
 
Company Designee 2
                                           *Please mark an asterisk * next to preferred email address for Rotary correspondence
Name: _____________________________ Title: _____________________________________
Business Phone: _______________Fax: ________________ E-mail: ______________________
Business Adress:________________________________________________________________
Home Address: _________________________________________________________________
Home City/State/Zip: ______________________Home Phone: __________________________
Home E-mail: __________________________________________________________________
 
Company Designee 3 (if applicable)
                                           *Please mark an asterisk * next to preferred email address for Rotary correspondence
Name: _____________________________ Title: _____________________________________
Business Phone: _______________Fax: ________________ E-mail: ______________________
Business Adress:________________________________________________________________
Home Address: _________________________________________________________________
Home City/State/Zip: ______________________Home Phone: __________________________
Home E-mail: __________________________________________________________________
 
Company Designee 4 (if applicable)
                                           *Please mark an asterisk * next to preferred email address for Rotary correspondence
Name: _____________________________ Title: _____________________________________
Business Phone: _______________Fax: ________________ E-mail: ______________________
Business Adress:________________________________________________________________
Home Address: _________________________________________________________________
Home City/State/Zip: ______________________Home Phone: __________________________
Home E-mail: __________________________________________________________________
Adopted August 2015