About Sertoma
Join SERTOMA and You Can Make a Difference Too!
Please complete this form and click Submit. It will be sent to the club Secretary for approval. Membership is $30.00 /quarter and is due to the Treasurer.
Name: Address: Home Phone : Email : Name of Business : Job Title : Business Address: Business Phone : Spouse : Applicants Date of Birth : Send my correspondence to: Residence Business
Name:
Address:
Home Phone :
Email :
Name of Business :
Job Title :
Business Address:
Business Phone :
Spouse :
Applicants Date of Birth :
Send my correspondence to:
Residence Business
Type of Membership: (Check One) Charter Active Transfer Reinstated Associate Transfer/Life Reinstated/Life Corporate
This candidate is recommended by (SERTOMAN)
Date of Application By clicking Submit, you are aggreeing to the conditions of membership to the SERTOMA club.
Date of Application
By clicking Submit, you are aggreeing to the conditions of membership to the SERTOMA club.
