NORTHEAST LINK

Rotarian, Foundation Alum & Guest Registration 2008

This form is for Rotarians, Rotary Foundation Alumni & Rotary Guests.
Current Rotary Scholars & Fellows 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).

Alumni Dinner:
Dinner Options

Payment:

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

Hal H. Gerow
Oceans 7, Apt. 403
2947 S. Atlantic Ave.
Daytona Beach Shores, FL 32118

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 7th September 2008, 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 Karen Swaim Babin, Rotary District 7190
75 Vista Drive
Saratoga Springs, NY 12866
Tel: 518-587-7582
E-mail: ksbabin@nycap.rr.com

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