New Member Proposal Form

Zonta Club of the Joliet Area – New Member Proposal Form

Date:_______________

Name:___________________________________________________
(Last First Middle)
Home Address: ____________________________________________
Home Phone:________________ Home Fax:____________________
Email:____________________________________________________

Birthdate: ________Family ___________________________________
Mobile:________________________ Personal or Business (Circle One)
Proposed member is: ____owner ____partner ____employee
S/he is _____a friend _____business acquaintance of _______years/months

Business __________________________________________________
Title: _________________________ How long in position ___________
Responsibilities/Decision-making capacity:
_________________________________________________________

Does s/he spend 50% or more time in this position? Yes No (Circle One)
Business Address __________________________________________
Work Phone __________________ Work Fax __________________
Work email: ____________________ Nature of Business __________

Hobbies/Interests: __________________________________________
Other memberships __________________________________________
________________________________________________________

Signature of Zonta sponsor __________________________________
Please indicate preferred contact: (Circle one & check preferences)
Home: ___ phone ___cell phone ___email ___US Mail
Business: ___ phone ___cell phone ___email ___US Mail

Classification: (Filled out by Membership Chair) ______________
Return completed form to: Beth Colvin (815) 386-7022
701 Hiawatha Dr. Minooka, IL 60447
bclvn26@aol.com