Registration

Registration has been extended until 3/20/2020

You may register the # of students that you wish (limit of 12)

Thank you for your interest in Rotary District 6900's 2020 Spring interact Leadership Conference. This year's conference will be held on March 28th at Camp Viola in LaGrange and is scheduled from 9:00 AM - 3:30 PM. We are structuring the day to include activities and opportunities for the students to both increase their leadership skills as well as their knowledge and understanding of Rotary International. Stronger leaders build stronger clubs so we are encouraging the students to use what they have learnt when they go back to their own clubs.

At this time please register your Interact members who you think will benefit from this conference and who will be club leaders for the 2020-2021 Rotary year.

Depending on the clubs’ responses, after the registration deadline you may be able to register an additional student or two.

Registration Deadline: 3/20/2020

Thank you for your continued contribution to Rotary and for your continued support for the youth in your community.

Barb

Question Title

* Interact Club information

Club Name

Sponsoring Rotary Club

Adviser's name

Adviser's cell number

Adviser's email address

Question Title

* Club Member 1

Name

Cell phone #

Emergency Contact (EC)

EC relationship

EC cell

List any food allergies

Any other concerns

Question Title

* Club Member 2

Name

Cell phone #

Emergency Contact (EC)

EC relationship

EC cell

List any food allergies

Any other concerns

Question Title

* Club Member 3

Name

Cell phone #

Emergency Contact (EC)

EC relationship

EC cell

List any food allergies

Any other concerns

Question Title

* Club Member 4

Name

Cell phone #

Emergency Contact (EC)

EC relationship

EC cell

List any food allergies

Any other concerns

Question Title

* Club Member 5

Name

Cell phone #

Emergency Contact (EC)

EC relationship

EC cell

List any food allergies

Any other concerns

Question Title

* Club Member 6

Name

Cell phone #

Emergency Contact (EC)

EC relationship

EC cell

List any food allergies

Any other concerns

Question Title

* Club Member 7

Name

Cell phone #

Emergency Contact (EC)

EC relationship

EC cell

List any food allergies

Any other concerns

Question Title

* Club Member 8

Name

Cell phone #

Emergency Contact (EC)

EC relationship

EC cell

List any food allergies

Any other concerns

Question Title

* Club Member 9

Name

Cell phone #

Emergency Contact (EC)

EC relationship

EC cell

List any food allergies

Any other concerns

Question Title

* Club Member 10

Name

Cell phone #

Emergency Contact (EC)

EC relationship

EC cell

List any food allergies

Any other concerns

Question Title

* Club Member 11

Name

Cell phone #

Emergency Contact (EC)

EC relationship

EC cell

List any food allergies

Any other concerns

Question Title

* Club Member 12

Name

Cell phone #

Emergency Contact (EC)

EC relationship

EC cell

List any food allergies

Any other concerns

Thank you. If you have questions about this conference please contact:
Barb Henigin
Interact Advisor
District Interact Chair
631.766.2491
rotary214babs@gmail.com