Membership Application Form

Thank you for your interest in joining the Rotary Club of Oakland!

Please fill out the following application form in order to begin your membership. Once submitted, our staff will be in contact to finalize your membership process.

Membership Application Form

Name and Title

Name *

Nickname for Badge *

Title or Position *

Business Contact

Business Name

Business E-mail

Business Phone

Business Address

Country

Address 1 *

Address 2

City *

State *

ZIP code *

Home Contact

Cell Phone

Home E-mail

Home Phone

Home Address

Country

Address 1 *

Address 2

City *

State *

ZIP code *

Detailed Info

Primary Contact Preference *

Date of Birth *

Month

Day

Year

Life Partner/Spouse Name

My Profession/Field of Work

I am a former Rotarian. The Club and date of membership were

Dues and Agreements

I am paying the required initiation fee of $300 with this application. Click here to pay application fee

Once inducted into the Club, I understand that I will be obligated to pay dues, prorated for the month in which I join. Dues are invoiced semi-anually. Upon induction, I consent to publication of my name, photo and brief bio on the Club's website and social media sites.

Signature

Use your mouse or finger to provide a signature in the box below

Signer Name *

Signer Title *

Leave this field blank