Rotary District 7810 - 2019 Conference

    Friendly Fredericton, N.B. Canada. - September 27 - 28th      


Rotaracts are invited to register for the full conference using the registration form found on the REGISTRATION PAGE of the website.  If you have any questions please contact Ben Graham at email address

The Rotaract registration fee is $50.00 per person.

Name _______________________________T-Shirt Adult Size: (circle) XS.  S. M. L.  XL. XXL.

Male ____Female_____ Other ___Cell Phone # ____________________

Age ______   Grade _______   School/College/University __________________

Registration:  $50.00 paid by:  Self_______. Sponsor_________. Host Club_________

Member:   Interact ______  Rotaract  _______   YEP______. Other __________

Name of Sponsoring Rotary Club: _____________________________________

Name of ADVISOR associated with above sponsor_________________________

Advisor’s E Mail: __________________________Cell Phone # _______________

Community Activities Involved In:  ______________________________________


School/ College/University Community Activities Involved In : __________________________________________________________________

Personal Interests (Other than previously mentioned): ______________________


Medical /Dietary concern/ Physical limitations/ (Epi Pen for? Allergies?) ___________________________________________________________________

Name of ADVISOR / ADULT / PARENT (circle one) travelling with to/from the

Conference:  ________________________________________________________

Driver’s Cell Phone #: ______________________________

Medicare #____________________________________

Parent’s Signature (Interact only) __________________________________

Media Photograph permission (circle one):     yes / no


Please return to email ??

Questions: ??