Soroptimist International of
Application for Membership
PLEASE PRINT CLEARLY USING BLACK INK
NAME________________________________________________________________________________________________
FIRM NAME
__________________________________________________________________________________________
TITLE OR POSITION HELD
____________________________________________________________________________
NATURE OF BUSINESS
________________________________________________________________________________
BUSINESS PHONE ______________________________ BUS. FAX ___________________________________________
BUSINESS MAILING ADDRESS
_________________________________________________________________________
BUSINESS PHYSICAL ADDRESS
________________________________________________________________________
BUSINESS E-MAIL ADDRESS
___________________________________________________________________________
Other Business Interests (please describe)___________________________________________________________________
_______________________________________________________________________________________________________
HOME PHONE _________________________________ HOME FAX __________________________________________
HOME MAILING ADDRESS
_____________________________________________________________________________
HOME PHYSICAL ADDRESS
____________________________________________________________________________
HOME EMAIL ADDRESS
________________________________________________________________________________
{Please mark (**) the contact
information you would like Soroptimist to primarily use}
Would you like your birthday listed in the Newsletter?
YES NO Month_____Day______
FAMILY MEMBERS
____________________________________________________________________________________________
____________________________________________________________________________________________
ORGANIZATIONS / AFFILIATIONS / OTHER
INTERESTS
____________________________________________________________________________________________
_____________________________________________________________________________________________
Mail
application to: SI – Stateline
_____________________________________________________________________________________________
To be
completed by Soroptimist Sponsor. APPLICANT
NAME:
______________________________________ Sponsor: How long have you known
this person? ___________________ How do you know the
applicant? To be
completed by Recruitment and Retention Committee. Date Application Received Date Presented to the
Board Recruitment
& Retention Comm. Date Letter of Invitation
Sent Orientation Date Induction Date Attendance Committee
Notified Newsletter Notified Roster Notified Treasurer Notified Fees Paid Committees Classification: Index Number: Membership Type: