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* 1. Thank you for your interest in our club. To apply for membership, please fill this form and send a CV to Manuela Mot (mmot@worldbank.org) copying Quentin Wodon (rotarianeconomist@gmail.com). This note is to make sure that you understand our membership dues. If your application is accepted, you hereby agree to pay to the club $100 upon joining independently of when you join. Thereafter, you will be billed $250 per year in two installments in June ($125) for July-December and in December ($125) for January-June. Reduced dues of $200 per year are available for members below 35 years of age and for spouses/partners of existing members. The club may change its dues in the future if the board so decides. Continued membership is contingent on being up-to-date on dues. Please type your initials in the box below to indicate your agreement.

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* 2. Title (Mr., Ms., Mrs., Dr., etc.)

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* 3. First name

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* 4. Last name

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* 5. Gender

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* 6. Date of birth (DD/MM/YEAR)

Date

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* 7. Are you a Rotarian or former Rotarian?

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* 8. If a Rotarian/former Rotarian, provide RI ID number if available

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* 9. Name of former club (last club if multiple)

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* 10. Are you a Rotary alumni (Interactor, Rotaractor, Peace fellow, Ambassadorial scholar, etc.)?

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* 11. Email

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* 12. Preferred phone number

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* 13. Alternate phone (if applicable)

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* 14. Preferred mailing address (not an email address - a  mailing address)

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* 15. Please indicate if the address is residence, business, or other

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* 16. Job title

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* 17. Name of business or organization

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* 18. Classification (type of job/profession)

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* 19. Could you tell us briefly how you heard about us?

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* 20. Please tell us about yourself (short bio)

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* 21. Are you interested in one or more service activities in particular? If so, please explain?

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* 22. Are you interested in making a short presentation on your work or passion at a club meeting? If so, indicate the topic

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* 23. Any comments on suggestion on priorities for the club?

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