be sure that your Club & district
Information is correct in the boxes below
Required
District Number:
Required
Rotary Club of:
Select appropriate REGISTRATION Packet
P-E = $310.00
AG = $310.00
All others = $230.00
Spouses = $190.00
Be sure that the correct
option is checked for the correct office or position for
which you are registering. Your registration fee is determined
by the office.
Register me as?
President Elect
Assistant Governor
Facilitators and Others
Badge Title
POSITION NOT LISTED
Discussion Leader
District Governor 07-08
District Governor 08-09
District Governor 09-10
PETS Operating Committee
PETS Guest
PETS (observer)
Ranger Chief
Ranger Chief Deputy
Ranger
Rl Representative
TRF Representative
Assistant Governors let us
know which term you are serving
AG Term:
SelectYear
FirstTerm
Second Term
Third Term
Registering
Spouse, or Not ?
NOTE:
Do not register your spouse if he or she is working as trainer
or facilitator , or if
he or she is registering as a PE, AG, DG,DGE,DGN, Board member,
or Speaker. In any of those cases the spouse must register
seperately
* Register Spouse?
Yes, I want to register my spouse
No, my spouse will not attend
No, my Spouse will register separately
Choices for Presidents-elect ONLY
Required Year As
President:
PE's
2008-2009
PN's
2009-2010 Note: President-Nominee attending this year must
also attend next year as President-Elect
Required Approximate
Club Size:
Pres-Elects Only
Presidents-elect who check "less than 3 years" of Rotary
membership may attend an optional session on Friday morning
from 7:00 to 8:45. If
you qualify and wish to attend be sure and select YES from the
Rotary Basics dropdown, otherwise select NO
Required
Years in Rotary?
less than 3 years
less than 10 years
less than 20
years
more than 20 years
Pres-Elects Only
Required
if Active
" I will attend Rotary Basics
"
NO
YES
Friday
Morning
7:00 am
Pres-Elects Only
The following Friday Morning
Special Optional Bonus
Sessions are offered from 7:00 AM to 8:45
AM. They will be held early Friday morning for those who arrive
Thursday, or who arrive early Friday an wish to attend. The 1st topic is from 7:00
AM
to 7:45 AM. The 2nd topic is from 8:00 AM to 8:45 AM. Choose the
session, or sessions, and the topic, or topics that you wish to attend.
NOTE! YOU DO NOT HAVE TO
CHOOSE ANY OF THESE SESSIONS.
Friday Options
First Session 7:00 - 7:45
Second Session 8:00 - 8:45
No t
attending
No t
attending
Topic
Options #1
Electronic Media and the
Rotary International Website
Electronic Media and the
Rotary International Website
Topic
Options #2
Preparation of a Club Budget
Preparation of a Club Budget
Topic
Options #3
Planning
for a Successful Fund-raiser
Planning
for a Successful Fund-raiser
Topic
Options #4
Personal
Leadership Development
Personal
Leadership Development
Topic
Options #5
Membership Development
Membership Development
--- Primary Registrant's name ---
Be sure your
name is spelled correctly, and the "call" and last names are in
the correct boxes. Your "call" name is the name by which
you are addressed at the club meeting. These names as
entered will be printed on your badge. Maximum length is 12
characters or spaces on the "call" name and 20 characters on the
last name.
Required
Call or Nick Name
( ie. " Ted", "WW", "Gini")
Max12 characters
Required
Last Name only :
Max 20 characters
Avoid hyphenated married
names if possible.
Primary Registrant's Contact
Information
Fill in all
fields marked as "Required" Your confirmation
will come to you via e-mail, so be sure that the E-mail address is correct.
Required Mail
Address:
Required
Mail City:
Required
State or Province:
Not Applicable
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Dist. of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Required
Zip Code:
Required
Home Phone:
In this format only 999-999-9999
Business Phone:
In this format only 999-999-9999
Fax:
In this format only 999-999-9999
Required E-Mail:
Must be correct. Please double
chec k.
The Home phone number and e-mail address
are both required. If
you do not have an e-mail, enter the e-mail of a close friend or
relative, so that they can forward any replies or questions to
you. If you have an unlisted home phone number and do not wish
to be contacted for any reason, enter 999-999-9999 in your home
phone number field: . Business phone and fax are not
required, but can be entered to enable better communication.
This information will be distributed to all Presidents-elect and
Assistant Governors-Elect at PETS.
spouse/Guest's
information
You must fill in the call name
and last name of your spouse or guest only
if you are registering
them at this time.
Required
if Active
Call/Nick Name
Name will appear on your badge, 12
characters max.
Required
if Active
Last
Name
Name will appear on your badge, 20
characters max.
Badge Title
Title will appear on badge. Limit 20 characters
TOTAL PAYMENT DUE
Total
Registration
If this amount is not correct do not submit the form
P-E only= $310.00 Plus Spouse/Guest =
$500.00
AG only= $260.00 Plus
Spouse/Guest =
$500.00
PDGs & others = $180.00 Plus
Spouse/Guest = $420.00
Please u se (MasterCard or VISA only) to pay for your registration.
Required
Payment
Method
When you pay by credit
card,
Y ou
will need to have the following information during the credit card
authorization process: (1) Credit Card number , (2)
the expiration month and year , and (3)
The 3-digit credit-card-code verification number
(Last 3 digits on the back of the card).
(4) The address that the credit card statement
for that card is
sent to, and (5) The correct 5-digit Zip Code for that
address. You will receive a confirmation by
e-mail from the credit card authorization company, which you can give to
your club or district treasurer for your reimbursement. If, for any reason you do not complete the credit
card process, contact PDG Ed Martin at:
edpoemartin@aol.com ,
(713) 628-2918