Submit a Prospective Member

Registration for 2013 Annual Meeting and Reception

Friday, June 21, 2013

Meeting: 1:30 - 4:30
Reception: 4:30 - 6:00

Fill the registration form and click "Register" to go to the secure online payment page.

Registration Information

Cost is $30.00 per person

Rotarian Firstname:

Lastname:

District:

Club:


Leave spouse name blank if spouse is not attending.

Spouse Firstname:

Lastname:


Additional Guests ($30.00 each):

Billing Address

Address:

City:

State:

Zip:

Country:

Email:

Phone:


      

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