NORTHEAST LINK

Rotarian, Foundation Alum & Guest Registration 2010

This form is for Rotarians, Rotary Foundation Alumni & Rotary Guests.

Current Rotary Scholars & GSE participants please use the Scholar Registration Form

Registration now open.

Information for Badge

 

  
  Title  

e.g. Mr, Mrs, Miss, Ms, Dr, Prof

  
  First Name  

e.g. Robert

  
 
Family Name
   

e.g. Smith

  
 
Nickname / Call name
 

e.g. BOB (UPPER CASE)

 
  Gender  

 

  
     

 

  
Contact Information in USA or CANADA
 
Address  Line 1
 

e.g. 25 Main Street

  
  Address  Line 2  

 

  
 
City, St, Zip
 

e.g. Boston, MA 01234

 
 
Country
 

e.g. USA

  
 
Phone
 

e.g. 508-555-1212

  
 
e-mail
 

e.g. robert12345@hotmail.com

 
     

 

  
Rotarian & Guest Information
 
  Title  for Name-Badge  

Please select from list

 
  Rotary District #  

e.g. 7930

 
     

 

  
Foundation Alums  

 

  
  Alum Type  

Please select from list

 
  Study Years  

e.g. 2001-2002

  
  Study Institution  

e.g. Edinburgh University

  
  Study Country  

e.g. Scotland

  
  Field of Study  

e.g. Mathematics

 
     

 
Partner Information (if attending)

 

  
 
Partner's first name

e.g. Elizabeth

  
  Partner's family name

e.g. Smith

 
 
Partner Nickname

e.g. LIZ (UPPER CASE)

  
  Gender

 

  
 
Additional Information you would like NORTHEAST LINK staff to know (comments)

Registration Fee Schedule with and without hotel:

Registration Fee  
Roommate Preference (if sharing)  

The Registration Fee includes meals, seminar materials and hotel room (if selected).

Saturday Dinner Only Registration:
This is a chance for all Alumni to reconnect at NELINK. All Alumni and guests
are invited and encouraged to attend.

Registration Options

Payment:

A Check or Money Order in US Funds, should be made payable to NORTHEAST LINK and mailed to:

Klaus Hachfeld
50 McGregory Rd.
Sturbridge, MA 01566
klausdh@charter.net

Please indicate on the check or in an accompanying note, the names of the people whose registration is being paid by this check!

Deadline:

Please ensure that your registration is received by 18th September 2010, for hotel accommodations and meal tickets. 

All hotel reservations will be handled by NORTHEAST LINK.
Please DO NOT CONTACT THE HOTEL for reservations.

NORTHEAST LINK assumes no responsibility for any medical treatment and related service expenses incurred by you and others who may accompany you during travel for, and attendance at, the NORTHEAST LINK weekend.

For additional information, contact:

PDG Alan Hurst
Rotary District 7980
1 Spice Hill Drive
East Hampton, CT 0624
Tel: 860-267-2799
E-mail: alanhinct@aol.com

To subsequently change your reservation, use this form to re-register.