Professional Documents
Culture Documents
Tacloban City
PLEASE COMPLETE ALL SECTIONS.
REGISTRANT DETAILS
Family Name
First Name
Course
Middle Name/Initial
College
Contact Information Provide your current mailing address. Any changes will be reflected in your member profile.
Address
City
State/Province
Postal Code
Country
Home Phone
Mobile Phone
Home Fax
Email (Required and must be unique. Email address cannot be shared by another club member or club.)
Parent or Guardian Information Contact information for an adult is required for all registrants age 18 or younger.
Parent or guardian information will be used only for contact purposes and does not register the parent or guardian for the convention or any events.
Family Name
First Name
Middle Name/Initial
Name
Areas of interest:
Community Service
International Service
Professional Development
Youth Service
Club Service
1. Will you take part in 60% of the clubs social and service activities? Yes No
2. Are you willing to pay member dues?
Yes No
I understand and accept the principles of Rotaract as expressed in its purpose and objectives, and agree to comply with and be bound by
the Standard Rotaract Club Constitution, Rotaract Statement of Policy, and by-laws of the club.
_______________________________________
SIGNATURE OVER PRINTED NAME
Registrant