To the Board of Directors:

I propose      for membership in Fremont Rotary.
Business Address
Business City, State, Zip
Residence Address
Residence City, State, Zip
Approximate Age:
Has this individual ever been a member of a Rotary Club?	YES NO
Company/Institution
Name of Position
Principal Activity of Business
Activities which would enhance consideration as a Rotarian:
Rotarian Proposing New Member:
Name
Phone