DATA FORM FOR DISTRICT DIRECTORY 2018-19

Data Form for District Directory 2018-19

If you are human, leave this field blank.

Name of Rotarian *

Name of Spouse

Club

Mailing Address

Tel. No. (Office) with STD Code

Tel. No. (Residence) with STD Code

Mobile No. (Self)

Mobile No. (Spouse)

Email Address (Self)

Email Address (Spouse)

Date of Birth (Self)

Date of Birth (Spouse)

Date of Anniversary

President Year, if applicable

Rotarian Since (Year)

Blood Group (Self)

Blood Group (Spouse)

Self Photograph

Maximum file size: 2MB

Spouse Photograph

Maximum file size: 2MB

RotaryDistrict3011