1. SERVICE ABOVE SELF
Rotaract Membership Application
New Renewal
PERSONAL INFORMATION
Name
Last Name First Name Middle Name Nickname
Date of Birth Civil Status Age Gender Nationality
Home Address
Telephone Cellphone
Course and Year Email / Facebook
LEADERSHIP INFORMATION (Use additional sheets if necessary)
Organization Position Inclusive Dates Accomplishments
Please Indicate Available Schedule (Specific dates i.e. Friday, 5-7pm)
QUALIFICATIONS: DOCUMENTS REQUIRED:
Must be at least 15 to 30 years of age
• Physically/mentally fit 1. One (1) Coy of Completed Rotaract Membership Application
• Excellent work attitude Form
• Committed and dedicated to work
• Pleasant disposition 2. Two (2) Copies of 1” x 1” Picture
3. One (1) Copy of Completed Oath of Membership Form
Please check field of interest
Club Service (Concerned with the strengthening of the club organization through membership development, promoting acquaintance
and friendship and maintaining an efficient club operation, effective communication and information system)
Community Service (Concerned with providing opportunity to exemplify the Rotary Maxim “Service Above Self” through social
responsibility projects to improve the quality of life of people by addressing their needs and concerns and promoting the preservation of the
environment)
Vocational Service (Concerned with encouraging and fostering high ethical standards in business and profession, literacy
enhancement, career development, career development, enterprise development, and promotion of Industrial peace)
Youth Service (Concerned with providing opportunities to the youth to develop their talents, improve their life skills to ensure a better
future and reach out to the less privileged and disadvantaged youth)
International Service (Concerned with encouraging and fostering the advancement of international understanding, goodwill and
peace)
Statement of Waiver and Attestation
I hereby attest that all information indicated herein are true and correct to the best of my knowledge.
Furthermore, I voluntarily accept the risks and assume all responsibilities from any untoward incident that may arise in
the duration of my involvement as Member of Rotaract Club- University of Negros Occidental Recoletos Chapter.
______________________________ _____________________
Signature Over Printed Name Date Accomplished
It is the policy of this organization to provide equal opportunities without regard to race, color, religion, national origin, gender, age, or disability. Thank you
for completing this application form and for your interest in joining our Club. Personal information collected here will not be used anywhere other than club
records neither released to any third parties. Bylaws of this Club are based on Rotaract Handbook (www.rotaract.org) .
Not for Sale – May be reproduced
Rotaract Club of University of Negros Occidental Recoletos
Academic Year 2011-2012
www.facebook.com/rotaractclubofuno-r.com