Rydalmere Rotary


Application Form

School/College

Name:
Contact Name:
Phone Number:
Email:
 
Team Member 1

Name:
Address:
Post Code:
Home Phone:
Email:
Age:
 
Team Member 2

Name:
Address:
Post Code:
Home Phone:
Email:
Age:
 
Team Advisor

Name:
Address:
Post Code:
Home Phone:
Email:
Team Advisor is a:TeacherStudent
Will Advisor be attending?YesNo
Preferred Country:


Registration opens on the 21st Feburary 2008 and closes on the 19th April 2008
Costs: $220 per team (includes 2 students and 1 advisor)

Payment:
Option 1:Cheque payable to “ROTARY DISTRICT 9680 - MUNA”
post to: 12, Church Street, Ryde, NSW 2112.

Option 2:Rotary sponsorship
Preferred Rotary club
(leave blank if you wish us to appoint a local Rotary club)


Sponsoring Club (if available)

Rotary Youth Service Director or Rotarian responsible for MUNA is:

Name:
Phone:
Fax:
Mobile:
Email:
 
 
  


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