Nomination Form for a Candidate New to Rotary

Note to sponsor: Please work with the candidate to nominate a person for membership in the Rotary Club of Ann Arbor. Your nomination will be evaluated by the Membership Committee with a recommendation made to the Board of Directors at an upcoming meeting (normally the third Wednesday of the month). If the candidate has been a Rotarian or Rotaractor, they can seek reinstatement their own.

Name of candidate:*
First Last
Candidate's preferred mailing address:
Candidate's preferred email address:
Candidate's preferred telephone:
Candidate's number of years in the Ann Arbor area
Candidate's professional affiliation, e.g. organization or institution (principal one if retired):
Candidate's title or position (principal one, if retired)
Principal sponsor:
First Last
Other sponsors:
Rotarian completing this form:*
First Last
Rotarian's preferred email
Relationship(s) to the candidate and how each came to sponsor this person. Confirmation that you have reviewed the Committee Descriptions with the candidate and any indications of specific interest(s) would also be useful:
Please provide a synopsis of the candidate's professional accomplishments and altruistic activities that are consistent with the mission statement of Rotary below:
Rotary's Mission Statement: Rotary is a global network of 1 .2 million neighbors, friends, leaders, and problem-solvers who see a world where people unite and take action to create lasting change – across the globe, in our communities, and in ourselves.
Please note any experience the candidate has had with our club or Rotary, in general
Examples include friends/relatives who are Rotarians, Rotaract/Interact memberships, Rotary Youth Exchange, or visits to our club's meetings or projects.
What Rotary-related interests and passions will the candidate bring to Rotary?
What experiences or skills will the candidate hope to gain through membership in Rotary?

If you prefer to send a nomination form by USPS or email, please contact our Administrative/Financial Manager.

Nomination Form for a Candidate New to Rotary

Thank you to our sponsors