To be completed by the Rotarian sponsor:

I, _______________________ propose __________________ for membership in the Rotary Club
of Oakland with the possible classification of: _____________________________________________

To be completed by the applicant:
TO THE BOARD OF DIRECTORS, ROTARY CLUB OF OAKLAND:  I hereby apply for membership in the
Rotary Club of Oakland and give permission for my name and proposed classification to be published to the
Club membership.

Name _____________________________________ Nickname for badge _____________________

Title or position ____________________________________________________________________

Business Name ___________________________________________________________________

Business address _________________________________________________________________

City ____________________________ ZIP ________ Office E-mail: _________________________

Office phone _____/_____________FAX _____/______________Cell____/____________________

What is the nature of your business?__________________________________________________

What are your responsibilities?_______________________________________________________

List other activities that you are proud of_______________________________________________

_________________________________________________________________________________

++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++

Home address ____________________________________________________________________

City ____________________________ ZIP _________ Home E-mail: ________________________

Home phone _____/________________________  Home FAX: _____/____________

Date of Birth ___________Spouse's name __________________________________

If you are a former Rotarian, please list club and dates of membership: ______________________

_________________________________________________________________________________

I realize that 60% attendance at weekly luncheon meetings and/or committee meetings is expected.  I am able to comply with this requirement.  I understand that the one time initiation fee is $300 and that annual dues of $490 and a $100 tax deductible donation to Oakland Rotary Endowment may be paid in installments.

Signature___________________________________________ Date _____________

(Please return this completed application to the Rotary Office or fax to 510-451-2121)