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EXPRESSION OF INTEREST FORM

Please complete this form to express your interest in the

Rotary E-Club of Greater South Oz, D9500, Australia.

Once submitted we will contact you to discuss your application in further detail.

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|Name | |

|Home Address | |

|Postal Address | |

|Home Telephone | |Mobile: |

|Email | |

|New to Rotary? (Yes / No) | |

|Please share with us your interest in joining the club. |

|Please return this form when completed to Club President Graham Fussen |

|Graham@.au |

| |

|or Post to: The Rotary E-Club of Greater South Oz, |

|c/- Rotary District 9500 Inc., |

|Adelaide Halifax St. Post Office, |

|Halifax Street SA 5000 |

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