Rotary District 7500

District Conference Registration Page

Please read everything before you start entering information

Fellow Rotarians:

This web page lets you begin your registration for the 2010 district conference in Rehoboth Beach, DE. When you submit the form, it will be emailed to the Conference registrar. Your registration is complete when payment is received. if you wish to pay by Credit Card, we'll call you to get your card information.

Instructions

Please indicate your Club Name and fill in the form below (using your keyboard and mouse) and then hit the Submit button on the bottom left of this page.   Please also use upper and lower case letters when appropriate (example: John Smith is correct, JOHN SMITH or john smith is incorrect).

If you are unable to complete this form and would like me to walk you though filling it out over the phone, please e-mail me at smithrotarymath@aol.com and I will call you to setup a time.

We will e-mail you a confirmation listing of the information you sent us to check for accuracy .Be sure to indicate how you wish to make payment!
 Rotarian Information
Club Name click the down arrow with your mouse to select
Rotarian Name 
Nickname
Address
City
State click the down arrow with your mouse to select another state
Zip
Home Phone please enter without spaces or dashes - 6095551212 or enter "none"
Work Phone please enter without spaces or dashes - 6095551212 or enter"none"
Ext (if any)  Ext  please enter without spaces or dashes - 200 or enter "none"
Cell Phone please enter without spaces or dashes - 6095551212 or enter"none"

E-mail

 or enter "none"
 Others Attending with you

Partner     Guest       Rotarian from:

Guest Name
Guest Nickname

Children's Names
 Your Rotary Positions
Position  click the down arrow with your mouse to select
Position-2 click the down arrow with your mouse to select
Position-3 click the down arrow with your mouse to select
Position-3 click the down arrow with your mouse to select
 Patner/Guest Positions
Position  click the down arrow with your mouse to select
Position-2 click the down arrow with your mouse to select
Position-3 click the down arrow with your mouse to select

Position-3

 click the down arrow with your mouse to select
 Conference Pricing
 Two Occupants $695
 Single Occupant $560
 Thursday Night (room only) $120
 Sunday Night (room only) $120
 Children in room (under 12 free) $18 each
Children meals (2 breakfast & 2 dinners) $60 each
Hospitality Suite - Call -
 Special Needs

Please indicate if you have physical, dietary or other special needs. We will do our best to accomodate.

My need is:

 Credit Card and Payment

We can process your payment by credit card if you wish. As this form is not secure, we don't take credit card information now. Check the selection below to have someone call you, or send a check - today!

Call me to get my credit card information.

I am mailing a check to 

Rotary District 7500
P.O. Box 105
Moorestown, NJ 08057

Or, call Steve Smith, Registrar, at (856) 235-2889 and give him your credit card information
 

After you have checked the above information

Click the Submit button (below left) when finished or Start Over

button (below right) to clear the form (registration not submitted)