Rotary Multi-District Training Seminar

On-Line Submission Form

Select Appropriate Registration Option

I

  
Option 1:  Rotarian Only Fee = $60.00
Option 2: Rotarian & Guest
Cost for the spouse is $40 (does not include the training materials).		 Fee = $100.00
 
Rotarian
First Name:
Last Name:
Badge Name:
 
Guest/Spouse if attending:
Note:  DO NOT enter the guest/spouse's name UNLESS the spouse will be attending. 
Guest/Spouse Full Name:
Guest/Spouse First or Nick Name:
Guest/Spouse's Rotary Club:
   
Contact Information
Address:
City:
State:
Zip:
Home Phone:
Work Phone or Cell:
Fax:
E-Mail:
District:
District Office That You Hold:
Session Attending:

Please take a minute to review your selections and information before submitting the form, as you will not be able to correct or re-enter it. If you need to correct something, please contact: Bill Rains