MyEventRunner - Event Public Fill

Optional: Do you have a ClubRunner login?

User Name:

Password:

Your Information

Rotary Title::

Call Name (first name on name badge):

First Name:

Last Name:

Email:

Preferred Phone Number: ONLY TYPE IN NUMBERS WITH NO DASHES/SPACES/PERIODS ETC.:

I am registering as::

Repeating President # of years?:

District Number::

Enter District Number if not in Dropdown:

Club Name - FILL IN ONLY THE BLANK PART OF "Rotary Club of ................. (BLANK)":

How Many Members are in your Rotary Club::

If you have a disability and may require accommodations in order to fully participate please indicate here::

Please indicate what you would like to order for Thursday Dinner::

I consent to the collection, storage, and use of my information by Mid-Northeast PETS 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.

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