RYLA 2023 Nomination Form
*** for Rotarians only ***

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Contact Information
Optional: Do you have a ClubRunner login?
User Name:
Your Information
First Name:
Last Name:
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: