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Title:
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First Name:
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First name required
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Middle Initial:
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Family Name:
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Last name required
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Gender:
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Preferred Language:
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Former/Current Rotarian:
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Select Yes or No
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If Yes, RI Membership ID number:
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Only enter numbers, other characters not accepted
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Retired From Work:
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Former/Current Firm:
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Department:
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Position:
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Phone BH:
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This is not a valid phone number
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Phone AH:
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After hours phone number is required
This is not a valid phone number
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Mobile:
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Mobile phone number is required
This is not a valid phone number
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Email:
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Email address is required
Please use a valid email address
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Addresses
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Please complete your home address, the work and mail addresses are optional.
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Home
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Address:
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Street address required
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Suburb:
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State:
Suburb required
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Postcode:
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Country:
Postcode required
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Work
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Address:
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Suburb:
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State:
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Postcode:
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Country:
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Mail
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Address:
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Suburb:
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State:
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Postcode:
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Country:
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Send Postal Mail To:
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Select a preferred mailing address
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Rotary Magazine Subscription:
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It is a requirement of membership that you receive the monthly Rotary regional news magazine “Rotary Down Under”. The cost is $35 pa and this is included in your membership Fees.
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Members Site Login Details
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This members site requires a user name and password to gain entry. Enter your user name below. The user name should contain a minimum of 8 characters, alha characters, at least one number and not contain any non alpha characters ( e.g. "- _ . , @" ). Your user name is not case sensitive but password is!
Details of how the retrieve your system generated password will be sent via email. Once logged you can change your password.
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User Name:
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