Rotary District 7810 - 2019 Conference

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


ROTARY DISTRICT CONFERENCE


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 ben.graham17@gmail.com

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: ??