Registration Form

 Participants are limited to the USCC region. If you are interested in attending, you may attend Rotary Zone 22 and Zone 27 Rotaract Conference on "Youth, Leadership & Sustainable Development" at Hamilton, Ontario, Canada or INTEROTA in Rio de Janeiro, Brazil.

Last Name:

First Name:

Street Address:

City:

Province:

ZIP/Postal Code:

Country:

Phone Number:

E-Mail Address:

Chapter Name:

Sponsoring Rotary Club:

School Attending (If Applicable):

 

If paid

Registration Fee:

Early Bird:

by January 18, 2002:

$200.00

Pre-Registration:

by February 28, 2002:

$225.00

Registration:

by March 31, 2002:

$250.00

Late Registration:

after March 31, 2002:

$275.00

Registration includes: all meals except for one, 4 days and 3 nights housing and facilities at the St. Edward's University residence hall,, transportation between events, arrival/departure transportation, cruise on Lake Travis, USCC 2002 materials (including t-shirt, hand bag, logo lapel pin) and activities, as well as workshops and plenary sessions, and USCC 2003 $500 Host City Award.
Cancelation Policy: only half of the registration fee would be refunded if you register and decide not to attend. No refunds after May 31st, 2002 due to cancellations.

How will you be paying:
Check or Cash
 

If paying be check, please enter the check number:
Amount:

If you are paying by Check, please enter the check number here, send the form electronically and print it out to send it with your check to:
Ms. Mary Bogan
USCC2002 Conference
% San Jacinto College North
5800 Uvalde Road
HOUSTON, TEXAS 77049
USA
PLEASE BOOK YOUR FLIGHT TO AUSTIN, TEXAS

How will you be arriving:
If arriving by plane, please send flight information and arrival time:

Flight #:

Arrival Time:

Will you need to be picked up:
Yes
No

Are there any special needs:

Do you have a roommate preference:

Number of Guests Accompanying You:

Designed and maintained by:
For comments about website, please email: Vaneeta