New Member Application 950 New Member Application Hidden Member Status Current MemberIn ReadingsMoved AwayChanged JobsLost InterestStopped PayingDeceasedNo Reason for ending membership Member status or reason for leaving the club if no longer a member. Payment Status Value Not SetCompletedFailed Inducted Enter date inducted Reading1 Enter date of first reading Reading2 Enter date of second reading Reading3 Enter date of third reading Board Appproved Enter date of board approval Ended Approximate last day of membership Item Name Name * First Last * Last Home Address * Home Address Home Address Home Address City City State AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State Zip Code Zip Code Email * Home Phone Cell Phone * Business Name If applicable. Business Position or Title Business Email Business Address? Different Billing Address? Business Address Business Address Business Address Business Address City City State AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State Zip Code Zip Code Billing Address Billing Address Billing Address Billing Address City City State AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State Zip Code Zip Code Date of Birth Spouse/Partner Name Years in Community Membership Type * Weekly ($510/year includes lunch every Tuesday meeting and every 2.0 meeting) Monthly ($275/year includes one Tuesday meeting and one 2.0 meeting evening per month) Only the Application Fee is due today. You will be billed later for your membership. Past or Present Civic or Service Club Memberships (including other Optimist Clubs) with Offices Held If you have a Life Membership in another Optimist Club, please give the Club Name Special Skills or Hobbies Examples include woodworking, database, crafting. This can help us find areas where you can help. Photo Drop a file here or click to upload Choose File Maximum file size: 8MB Our member handbook includes headshots of members. Youth Contests Please Indicate your interest in the following: Essay Contest coordinate with teachers, publicity and judge Got Talent Competition recruit participants, publicity and judge Oratorical Contest coordinate with teachers, publicity and judge Visual Arts Competition coordinate with teachers, publicity and judge Youth Photography Contest coordinate with teachers, publicity and judge Member Related Please Indicate your interest in the following: Adult Socials identify theme, publicize and organize events Membership assist in recruiting and retaining new members Marketing/Publicity contact media with newsworthy information regarding the club Optimist 2.0 organize monthly meetings, arrange speakers and attend evening events Photography provide still pictures and video of club meetings and events Program Speakers identify and arrange speakers for weekly meeting Sergeants-at-Arms prepare room for meeting and assess fines Social Media prepare content for social media platforms, plan social media strategy Technology website, directory, communications and data management Weekly Bulletin – CNOtes website, directory, communications and data management Youth Activities Please Indicate your interest in the following: Childhood Health and Wellness provide support to children at Dayton Children’s Hospital Easter Egg Hunt buy supplies, stuff eggs, advertise and coordinate event Fishing Derby registration, concession stand and back office Haunted Trail assist with decorating trails, act as trail guide Kids’ Day in the Park set up games, help kids play and tear down after Safety on Wheels Bike Rodeo distribute materials and assist with Rodeo Safetyville Square set up/tear down, session assistance Tri-Star Basketball registration, set up stations and guide kids through basketball challenges Tri-Star Soccer registration, set up stations and guide kids through soccer challenges Youth Mental Health Initiative provide support to children struggling with mental health issues Community Outreach Please Indicate your interest in the following: Americana 5K Run 5K run registration, course set up and staff result stations Americana Booth July 4th – plan, set up, take down and staff event Holiday Adopt a Child recruit members and coordinate donations to central office Scholarship Committee assist with selecting scholarship recipients, act as mentor to students University of Dayton Club attend meetings and support college club Youth Clubs liaison with elementary, middle & high school Optimist clubs Fundraising Please Indicate your interest in the following: Avenue of Flags provide local area residents with US Flags for holidays Tee Off for Youth Golf Classic contact sponsors, register golfers and staff event Tree Lot coordinate sale of Christmas trees Sponsor Name If you do not know anyone in the club just leave blank and we will pair you with someone. Completed application must be accompanied by $60 application fee. Individuals who have committed offenses against children may be denied membership and/or have their membership revoked. Centerville Noon Optimist “No-Solicitation” PolicyAs a club who serves as a Friend of Youth, we want our volunteer members to be focused onhelping kids – free from business solicitation of any kind. Therefore all CNO Members arespecifically prohibited from contacting other club members for business solicitation purposes.Your application for membership affirms your acceptance and compliance with this policy. Application Fee This covers initial expenses like 3 lunches at Yankee Trace and name badge. Method of Payment Credit Card PayPal Check You will be redirected to PayPal to complete your payment after submitting this form. Payment Signature * signature keyboard Clear Date Captcha Future Ideas Tech Area Test Mode Turn on so payment is not asked for Submit If you are human, leave this field blank. Δ