English
RYLA 2023 Nomination Form
*** for Rotarians only ***
Please skip Payment by Credit Card to have your Club Billed Directly by the District
Contact Information
Optional: Do you have a ClubRunner login?
User Name
:
Password
:
New and existing users: retrieve username and/or reset password
Your Information
First Name
:
Last Name
:
Email
:
Preferred Phone
:
Secondary Phone
:
Nominee Address Line 1
:
Nominee Address Line 2
:
Nominee City
:
Nominee Postal Code
:
Nominee Name (First and Last)
:
Nominee's School Name
:
School Staff Contact Name (First and Last)
:
School Staff Contact (Telephone or EMail)
:
Nominee's E-Mail Address
:
Food Allergies
:
Reason for Nomination
:
T-Shirt Size
:
-- -- Please Select -- --
XS
S
M
L
XL
XXL
I consent to the collection, storage, and use of my information by Rotary District 7010 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.
Select Options