Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form. - Step 1 of 4Applicant InformationThis information is required to enter you into our district database if your application is accepted.Name *FirstLastDate of Birth (mm/dd/yyyy) *Email *Mobile Phone *Home PhoneHow do you prefer to be contacted? (Select all that apply) *EmailPhoneText messageAddress *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWhere do you work?What is your role there?Rider Height (Feet) *Rider Weight (lbs) *NextCannonballs Cycling Team & YouThis section will help us learn a bit more about your interest in Rotary.How did you hear about us? (Select all that apply) *From a current or past memberAttended a fundraising event in the communitySearch engine results while researching volunteer/community organizationsWebsiteSocial MediaOtherOther (please specify): club Where cycling Name of the person who referred you *Which social media platform (if applicable)?FacebookInstagramLinkedInYouTubeProfile NameStrava Profile NameDo you currently ride a bicyle? *Road BikeMountain BikeGravel BikeOtherAre you currently affiliated with any cycling group, team, or club? *YesNoIf yes, please list the name of the group, team, or clubWhat is you riding experience? *Less than 1 year1 - 3 years3 - 5 years5 years or more.Briefly share your riding experienceNextPreferencesPlease share your Rotary preferences to help us ensure the best fit.Why are you interested in joining Rotary? (Select all that apply) *To become a better riderSeeking to ride with other cyclistsMeeting new people opportunitiesTo networkTo make new friendsTravel opportunitiesOtherOther (please specify):Agreement *I agree to the terms below.I understand that if my application is accepted, I will be expected to participate regularly and pay annual dues.NextUpdating preview…This is a preview of your submission. It has not been submitted yet! Please take a moment to verify your information. You can also go back to make changes.PreviousSubmit