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1. Is it the TRUTH?  2. Is it FAIR to all concerned?  3. Will it build GOOD WILL and BETTER FREINDSHIPS?  4. Will it be BENEFICIAL to all concerned?
     
The Fairbury Rotary Club Application Information Form
 
Please fill out this form so that we may contact you with the necessary information you have requested.

 

Mr.   Dr.   Mrs.   Ms.

Name:             
Company:          
Position/Title:    
Street Address:
City:                   
State:               
Zip:                  

Phone:             
                           e.g. xxx-xxxx; no parentheses
Fax:                   
                           e.g. xxx-xxxx; no parentheses

E-Mail:               
                    e.g. your name@company.com

 

If you were referred by someone, please identify that person below...

Name:                 
Contact/Phone:  


     

Thank you for your interest in the Fairbury Rotary Club. Our policy is to never resell or distribute information provided in this form to any third party. We use this data exclusively to provide you the information that you have requested.  Thank you.
 

  Josh Clemons, Kecks Agency, 118 North 3rd. Street, Fairbury, IL 61739   (815) 692-2343