NORTHEAST LINK

Scholar & GSE Registration 2010

This form is for Current scholars & GSE participants.

Rotary Foundation Alumni please use Rotarian 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    
       
Scholar Country of Origin    
  State & Country   e.g. New South Wales, Australia
       
Scholar 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
       
Scholarship Information
  Scholar Type   Please select from list
  Study Years   e.g. 2006-2007
  Study Institution   e.g. Boston College
  Study Country   e.g. USA
  Field of Study   e.g. Early American Literature
     
Scholar’s Hosting/Sponsoring Rotary District in the USA or CANADA
  Rotary District #
e.g. 7930
  Host/Sponsor Counselor's Name
e.g. Harry Jones
  Host/Sponsor Counselor's Phone e.g. 617-425-1234
  Host/Sponsor Counselor's email e.g. harry.jones@abcinsurance.com
       
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 the scholar would like NORTHEAST LINK staff to know (comments)

Registration Fee Schedule:

Registration fee, incl accommodations  
Roommate preference  

Cost:

Single Scholars:

The $150 Registration Fee includes meals, seminar materials and shared hotel room. Scholars are encouraged to share a hotel room in order to enhance the Rotary Ambassadorial experience.

Scholar accompanied by their Partner:

The $300 Registration Fee includes meals, seminar materials and private hotel room for two people.

Payment:

We request that you, the scholar, contact your Host/Sponsor Counselor in the USA or Canada, to ask their club or District to pay for you. 

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.