Registration Form

Conference Fee

Full Conference includes:

Friday Reception and performance by the renowned All You Need Is Love Beatles celebration band, Saturday Daycare, Saturday Luncheon and Key-Note Speaker, Workshops, Saturday evening Gala Dinner.

Sign up for:

Conference Options
All taxes included

Per Person:

Friday Home Hospitality (limited avail. book early)

n/c   

Saturday Conference, all meals included

$175   

Saturday and Sunday Conference, all meals included

$225   

Saturday lunch and Key-Note Speaker only

$ 45   

Hotel (one price, single or double occupancy)
All taxes included

1 Night - Choose either Friday or Saturday

$145   

2 Nights Friday and Saturday

$290   

Daycare

If required, how many children?

Free

Friday Golf at Trillium Woods

Please send me more information

Personal Information
Rotarian
Rotary Club
Classification
Guest Name
Classification
(if applicable)
Mailing Address
Street
City
Postal Code
Phone
Bus
Res
Fax
Email
Future contact method? (Please check one) Mail Fax Email
Contact Information in case of emergency
Name
Phone
Please state any special medical, dietary or accessibility needs:
Payment Methods
Payment Amount
Cheque
Cheque Enclosed
  (Made payable to Rotary Dist. 7070 Conference)
Credit Card
MASTERCARD    VISA
AMERICAN EXPRESS
Card No.
Expiry Date
Name on Card
Signature

Until our SSL secure system is in place, for your own protection, please do not send us your credit card information by email.

Print and return form to :

Vince Lynch
Rotary District 7070 Conference 2003 Registration
P.O. Box 22082
Belleville, Ontario, Canada
K8N 5V7

Phone: 613-967-8636
Fax to: 613-969-0173

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