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Rotary International-District 7640
District Conference-Seaview
November 15-17, 2013
Contact Information
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User Name
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User name is a required field.
Password
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Password is a required field.
New and existing users: retrieve username and/or reset password
Your Information
First Name
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Last Name
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Badge Name
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Email
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Club Name
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-- Select Club --
-- Input club name --
Preferred Phone
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Secondary Phone
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Address 1
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Address 2
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City
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Zip/Postal Code
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Country
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State/Province
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Are you a Veteran ?
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Do you have any dietary restrictions?
:
Please explain:
:
Saturday's Gala Dinner Choice
:
-- -- Please Select -- --
Fish
Chicken
Beef-cooked medium
Beef-cooked well done
Beef-cooked rare
Vegatarian
I consent to the collection, storage, and use of my information by District 7640 as described in this
Privacy Policy
. I understand that I may receive emails regarding this event and other relevant information, and can opt out at any time.
Required
Group
:
Rotarian
Guest
Youth Exchange Student
Your Partner/Guest Information
First Name
:
Last Name
:
Badge Name
:
Email
:
Club Name
:
-- Select Club --
-- Input club name --
Preferred Phone
:
Secondary Phone
:
Address 1
:
Address 2
:
City
:
Zip/Postal Code
:
Country
:
State/Province
:
Are you a Veteran ?
:
Do you have any dietary restrictions?
:
Please explain:
:
Saturday's Gala Dinner Choice
:
-- -- Please Select -- --
Fish
Chicken
Beef-cooked medium
Beef-cooked well done
Beef-cooked rare
Vegatarian
I consent to the collection, storage, and use of my information by District 7640 as described in this
Privacy Policy
. I understand that I may receive emails regarding this event and other relevant information, and can opt out at any time.
Group
:
Rotarian
Guest
Youth Exchange Student
Select Options