Rotary International District 5170

Note: This form will email the results using your own email program (if you use Outlook Express, then it will attempt to send the message using Outlook Express). For security, a window should pop up and ask you to verify that you are trying to access your email. If you agree, the email will be sent. Otherwise, you will need to send the information yourself, to membership@rotary5170.org - Please include all fields.

Note: Please submit only once! Verify that you sent the email by looking in the Sent folder of your email program (Outlook Express if that is what you use for sending/receiving email).

If you are sending an e-mail to membership@rotary5170.org, include the following information:

• Reporting for the Month of: _____
• Club Name: _____
• Your Name: _____
• Report as of Month/Day/Year: _____
• Members: _____
• Members Gained: _____
• Members Lost: _____
• Number of Meetings: _____
• Average Attendance: _____ %
• Comments: _____

Thank you!