Picton Rotary Membership | Picton Rotary Club

Membership Application Form

Proposal for Membership of Rotary Club of Picton

Please complete the form below and our membership department will contact you as soon as possible.

Step 1 of 2 - Personal Details

Name*
First Last
Home Address*
Street Address Address Line 2 City Province Postal Code
Home Phone*
Mobile Phone*
Date of Birth*
Date Format: DD slash MM slash YYYY
Partners Name*
First Last
Children's Names
Please add your children's names and their ages ( if under 18 )