Registration

Providing Training
For All Rotarians

Observer, Graduate and Discussion Leader Registration Form
Registration for these courses is by Invitation only

                                            Observer                   Graduate
                           Discussion Leader....................................................
    All registrations and fees must be received by the Registrar at least 10 days prior to the course date.

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fields highlighted in royal blue are required

Your (Full) Name*
Your Nickname	R.I. Number Your nickname is used as your badge name. Your R.I. Number is assigned by Rotary International and is listed on the mailing label of the Rotarian magazine. It is the first item on the 2nd line down on the label. Your Rotary Club Secretary can also provide you with this number.
Approved By Your District RLI Director: (Name)	You must be approved by your District’s RLI Director in the district you are a member
District
Rotary Club of
Mailing Address
City	State Zip
Phone Home (include area code)	Business

E-Mail Address (please include)
I am registering for Location #	Choose Loc. # from list below (Recently changed)
I am registering for the Date of
Tell us if you/spouse plan to attend Friday Dinner	Quantity that will attend Friday Dinner Before Training Event

(Please print a copy of the confirmation page for your records after submitting form)