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Home > District Events > Club Leadership Retreat > Club Retreat Registration Form

Club Leadership Retreat Registration Form
 
Please complete this registration form for each individual attending the Club Leadership Retrat and Secretary Elect Training Seminar (SETS) to be held, May 17, 2008 on the ASU Beebe Campus in Beebe, Arkansas.

Note: Use the "TAB" key or your mouse to move to the next field on the form.  Pressing the "Enter" key will submit a partially completed form.  Thanks!

Rotarians' Information
First Name:   Robert not robert
Last Name:   Warner not warner
First Name for Badge:   Bob not bob
Rotary Club of:
2008-09 Club/Dist. Position:
  
Select the Position you will hold
during the 2008-09 Rotary year.
Address / Contact Information
Address:
City
State:
Zip:
Work Phone
Home Phone:
FAX:
Cell / Mobile:
E-mail:
Enter only one address		  
Form Submitted by:
Comments:

When you click on the submit button below, a copy of your registration will be e-mailed to the Meeting Registration Chair.  A confirmation copy will also be sent to the e-mail address entered above.

Thanks for using the District 6150 web site.
 

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