Rotary District 5130
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DG Jim and Kathy Flamson take a break from the Rotary Convention and visit "Margaritaville"
Photo courtesy of Linda Sinkay
District 5130 Centennial District Assembly Registration!
Return to Assembly Home Page


Registration Information
<All Fields are REQUIRED - Enter NONE if appropriate>

If you have already entered information, but have not submitted your final Assembly Registration, re-enter your email address (below) and click on "Retrieve Saved Entries / Review / Calculate Total Cost" to recall your saved profile

Name
Home Club
Address
City
State
Zipcode
Phone
Fax
Email
Your Non-Rotary Partner
(if Rotarian use spearate form)

Please check all that apply: (for name badge ribbons)
    Club President Club President-elect
Club Secretary Club Treasurer Club Director
Paul Harris Fellow Benefactor Major Donor
Bequest Society Past District Governor Past President
    AG DCC

Your Non-Rotary Partner:
Paul Harris Fellow Benefactor Major Donor Bequest Society

Event/Meal Registration Fees:
Friday April 1 Dinner $42 Beef Salmon Veggie
Saturday April 2 Assembly $40 Attitude Adjustment $5
 
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