Rotarian Action Group
for the
Alleviation of Hunger & Malnutrition

Membership Application
RAG for the Alleviation of Hunger & Malnutrition

*First Name:
*Middle Name (Initial):
*Last Name:
*Mail Address:
*City:
*State:
*Country:
*Telephone Number:
Fax Number:
*E-Mail Address:
*Rotary Club Name:
*Rotary Classification:
*Rotary District Number:
Areas of Interest:
Experience:
Annual Membership (US$20.00):
Lifetime Membership (US$100.00):
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