2008 District Conference Registration 1 Rotary District 6920 2008 District Conference Registration

Fill out and mail with your check to the address at the bottom of the form. Please enter the following information. The red fields are required

Registrant: Reg. Fee $35 ($45 after March 18) *Last Name: ______________________ *Badge Name: ____________________ *Address: ________________________ *City: ____________________________ *State: ___________ Zip: ____________ *Phone: __________________________ Email: ___________________________ *Rotarian ? Yes ____ No _____ *Club Name: ______________________			Guest: Reg Fee $35 ($45 after March 18) Last Name: _____________________ Badge Name: ____________________ Rotarian ______ Yes _____ No If YES then, Club Name: ______________________
Indicate all that apply for Rotarian:			Indicate all that apply for Guest:
_____ DGov _____ DGE _____ DGN _____ AG _____ Club Pres. _____ Pres. Elect _____ PDG _____ Past Club Pres.	_____ PHF _____ WWF _____ HTF _____ PH Society _____ Bequest Society _____ Major Donor	_____ DGov _____ DGE _____ DGN _____ AG _____ Club Pres. _____ Pres. Elect _____ PDG _____ Past Club Pres.		_____ PHF _____ WWF _____ HTF _____ PH Society _____ Bequest Society _____ Major Donor