Happy Hour Satellite Club ApplicationPlease enable JavaScript in your browser to complete this form.Name *FirstMiddleLastTitle (Optional)Nickname (Optional)Prefix (Optional)Suffix (Optional)Date of Birth (MM/DD/YYYY)Preferred Pronounsshe/her/hershe/him/histhey/them/theirsprefer not to sayFirm/Employer (current or former)Job Title (current or former)Preferred Email *Preferred Mailing Address TypeResidenceBusinessOtherOther Mailing TypeCommunication preferences (select all that apply)EmailPhone (Texting)Social MediaMailOtherOther Communication PreferencesPreferred Phone NumberAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeAre you a former or current Rotarian?YesNoRI membership ID number:Name of former/current club: of you magazine Your membership includes a print magazine subscription. Which magazine subscription would you prefer? (select all that apply)“The Rotarian” magazineRotary regional magazineDigital subscriptionsSpouse/Significant Other’s NameChildren’s Names/AgesHobbies Outside of WorkHeadshot Image Click or drag a file to this area to upload. Submit