Part 2: Approved Member Supplemental Information

This is Part 2 of a two-part form. This part should be filled out entirely by the approved member along with his club mentor. The form should be signed by the new member and their mentor. Upon completion, this form along with a check for dues should be given to the club treasurer.

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Your Name(Required)

First Last

Classification(Required)

Spouses Name(Required)

Anniversary Date(Required)

Member Birth Date(Required)

Children's Names(Required)

Schools Attended(Required)

Degrees Held(Required)

Special Interests / Languages(Required)

Community Achievements(Required)

New Member's Name(Required)

Date(Required)

Mentor's Name(Required)

Mentor's Email(Required)