ESRAG Membership Membership SignUp YES! I would like to join ESRAG (Information provided will be used strictly for ESRAG use unless otherwise instructed) (If you are a returning member please log into your account to renew your membership.) iMembersDB Login Applicants are asked to complete the following information. Starred items(*) are required. After completing this form, click ‘Submit’. A copy of this application will be emailed to you. Or you can also print this form and mail it to the address below. Member Information: * First Name: * Last Name: * Email Address This email is already in the system. Please email membership at email@example.com to change your membership type. * Are you a: Rotarian Rotaractor Non-Rotarian * Club Country: * State/Province: * Club Name: Billing Address: * Address1: (Address) Address2: (Ste/Suite) * City: State Code: Province: Country Code: *Postal Code: Captcha Code: Westwind Systems, dba iMembersDB, LLC is collecting the above personal information on behalf of Environmental Sustainability Rotary Action Group (ESRAG) in order to process your online application for ESRAG participation. Our organizations do not sell your personal information. The Registrant authorizes the ESRAG to collect and use personal information about the Registrant for the purpose of receiving communications and the purposes described in the ESRAG policies relating to privacy. The Registrant grants permission to ESRAG to photograph and/or record the Registrant’s image and/or voice on still or motion picture film and/or audio tape, and to use this material to promote the ESRAG through social media, newsletters, websites, television, film, radio, print and/or displays. The Registrant understands that they waive any claim to remuneration for use of audio/visual materials used for these purposes. Permission may be withdrawn at any time by contacting the ESRAG’s Privacy Officer. The Privacy Officer will advise the implications of such withdrawal. Please check the "I Consent" checkbox below to allow us to collect, use, and disclose your personal information as described above. I Consent Problem! There was a system error creating your new membership. Please contact support to resolve this issue.