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Rotary District 7040 Conference
May 3-5 2024
1000 Islands Harbor Hotel
Clayton, NY
Contact Information
Anna Van Adrichem Rochon
anna.varochon@gmail.com
343-548-2706
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Your Information
First Name
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Last Name
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Email
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Club Name
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1000 Islands (Brockville)
Alexandria Bay
Arnprior
Au Sable Valley
Barrhaven
Brockville
Canton
Carleton Place and Mississippi Mills
Cataraqui-Kingston
Chateaugay
Chesterville
Clayton
Cornwall
Cornwall Sunrise
d7040 Passport
East of Montreal
E-club Premier 7040
Eganville
Gananoque
Hawkesbury
Hull
Iqaluit
Kanata Rotary Club
Kemptville
Kingston
Kingston Waterfront
Kingston-Frontenac
Lake Placid
Laval Rive-Nord
Malone
Massena
Montreal
Montreal Ville-Marie
Montreal West & NDG
Montreal-Lakeshore
Mont-Tremblant
Napanee
Nepean-Kanata
North Renfrew Rotary
Ogdensburg
Old Montreal
Orleans
Ottawa
Ottawa Bytown - Bytownrotary@gmail.com
Ottawa Metro
Ottawa South
Ottawa-Stittsville
Pembroke
Petawawa Rotary
Plattsburgh
Plattsburgh Sunrise
Potsdam
Renfrew
Rotaract Club of Kingston
Rotaract Collège Jean-de-Brébeuf
Rotaract Downtown Montreal
Rotaract l'île de Montréal
Rotaract Metro Montreal
Rotaract Ottawa
Rotaract Ottawa South
Rotaract Queens
Rotaract SUNY Plattsburgh
Saranac Lake
Shawville
Smiths Falls
St. Jerome
Theresa
Tupper Lake
Valleyfield
Watertown
Watertown Sunrise
West Ottawa
Westmount
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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PDG, or in the Governor Stream
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No
Are you an Assistant Governor
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No
Yes
All meals will be buffet and items will be clearly marked as gluten free, vegetarian etc. Please list any additional dietary restrictions.
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District # if not 7040
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I consent to the collection, storage, and use of my information by District 7040 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
:
All Attendees
Rotaract/Youth
Your Partner/Guest Information
First Name
:
Last Name
:
Badge Name
:
Email
:
Club Name
:
-- Select Club --
-- Input club name --
1000 Islands (Brockville)
Alexandria Bay
Arnprior
Au Sable Valley
Barrhaven
Brockville
Canton
Carleton Place and Mississippi Mills
Cataraqui-Kingston
Chateaugay
Chesterville
Clayton
Cornwall
Cornwall Sunrise
d7040 Passport
East of Montreal
E-club Premier 7040
Eganville
Gananoque
Hawkesbury
Hull
Iqaluit
Kanata Rotary Club
Kemptville
Kingston
Kingston Waterfront
Kingston-Frontenac
Lake Placid
Laval Rive-Nord
Malone
Massena
Montreal
Montreal Ville-Marie
Montreal West & NDG
Montreal-Lakeshore
Mont-Tremblant
Napanee
Nepean-Kanata
North Renfrew Rotary
Ogdensburg
Old Montreal
Orleans
Ottawa
Ottawa Bytown - Bytownrotary@gmail.com
Ottawa Metro
Ottawa South
Ottawa-Stittsville
Pembroke
Petawawa Rotary
Plattsburgh
Plattsburgh Sunrise
Potsdam
Renfrew
Rotaract Club of Kingston
Rotaract Collège Jean-de-Brébeuf
Rotaract Downtown Montreal
Rotaract l'île de Montréal
Rotaract Metro Montreal
Rotaract Ottawa
Rotaract Ottawa South
Rotaract Queens
Rotaract SUNY Plattsburgh
Saranac Lake
Shawville
Smiths Falls
St. Jerome
Theresa
Tupper Lake
Valleyfield
Watertown
Watertown Sunrise
West Ottawa
Westmount
Preferred Phone
:
Secondary Phone
:
Address 1
:
Address 2
:
City
:
Zip/Postal Code
:
Country
:
State/Province
:
PDG, or in the Governor Stream
:
-- -- Please Select -- --
Yes
No
Are you an Assistant Governor
:
-- -- Please Select -- --
No
Yes
All meals will be buffet and items will be clearly marked as gluten free, vegetarian etc. Please list any additional dietary restrictions.
:
District # if not 7040
:
I consent to the collection, storage, and use of my information by District 7040 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
:
All Attendees
Rotaract/Youth
Select Options