Contact Information
BASIC REGISTRATION FEE IS REQUIRED FOR ALL ATTENDEES.

IF BOTH SPOUSES/PARTNERS ARE ROTARIANS, you can complete just one (1) form and simply designate them as "Rotarians" at the bottom of each column.
Optional: Do you have a ClubRunner login?
User Name:
Password:
Your Information
First Name:
  
Last Name:
  
First Name for Badge:
If YE Student, list Country:
Email:
  
Club Name:

District Officer? Please Select.:
District Committee Chair? Please select ONE.:
Past District Governor?:
(Rotarian Only) First District Conference?:
Preferred Phone:
Address 1:
City:
Zip/Postal Code:
Country:
State/Province:
Group:
Your Partner/Guest Information
First Name:
Last Name:
First Name for Badge:
If YE Student, list Country:
Email:
Club Name:

District Officer? Please Select.:
District Committee Chair? Please select ONE.:
Past District Governor?:
(Rotarian Only) First District Conference?:
Preferred Phone:
Address 1:
City:
Zip/Postal Code:
Country:
State/Province:
 
Group:
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