__I hereby certify that I am personally and actively engaged in the business or profession or professional activity covered by the classification that has been proposed for me and that my place of business or residence is located within the territorial limits of the club or within the corporate limits of the city in which the club is located or within an immediately adjoining territory.
__I understand that it will be my duty, if elected, to exemplify the Object of Rotary in all my daily contacts and activities, and to abide by the constitution and bylaws of the club. I understand that part of my membership dues will provide me annual subscription to the official magazine or an approved and prescribed regional magazine as may be applicable. I agree to pay the admission fee and the annual dues in accordance with the bylaws of the club. I hereby give permission to the club to publish my name and proposed classification to its members.