Membership

Application
Online Form

    Building Communities
Gateway Rotary Club
P.O. Box 221
Ely, Iowa 52227 President Dean Sturtz
319-432-7363
dean.sturtz@omegap.com
Gateway Rotary Membership Application Form

Name *

First

Last
Address *

Street Address

Address Line 2

City

State / Province / Region

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Country
Home Phone Number *

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Work Phone Number *

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Cell Phone Number

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Email *
Confirm Email *
Business/Employer *
Job Title *
Reason(s) for wishing to join this club: *
Have you been a Rotary member before? *
 NO 
 Yes 
Interest and Hobbies
Family Information
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