New member questionnaire

Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Men's Night

Please check the box below if your spouse would like to be included on the Men's Night List.

Yes, please contact my spouse!

Birthday

MM

DD

YYYY

Photo Permission

Photo Permission

Yes, you may include a photo of me on your website or social media pages.

Member Directory

Please check the box below if you would like to be included in a members only directory.

Yes, you may include my name, phone number and address in a members only directory.

Service Requirement

We have instituted a new ask of all members this year, upon joining or renewal of membership, to commit to 2 hours of service through Madison Newcomers over the course of the year.

Yes, I will try to commit to 2 hours of service through Madison Newcomers over the course of the year.