Microsoft
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|APPLICATION FORM |
|SPONSORING | |
|ROTARY CLUB of | |
|SPONSORING COMPANY | |
|NAME |Surname | |
|OF | | |
|APPLICANT | | |
| |Given Names | |
| |Preferred Name | |( Male |( Female |
|DATE OF BIRTH | |
| | |Post Code | |
| | |
|POSTAL ADDRESS | |
| | |Post Code | |
|PHONE NUMBER | |
|MOBILE | |
|EMAIL | |
|OCCUPATION | |
|EMPLOYER | |
|EMPLOYER'S PHONE | |
|EMPLOYER'S EMAIL | |
|CLOSING DATE: |FINAL APPLICATIONS – 3rd April, 2018 |
| |(maybe earlier if we reach full capacity) |
|ABOUT YOU |
|What are your interests | |
|e.g. clubs, hobbies etc. | |
| | |
|What do you hope to get | |
|out of the RYLA Seminar | |
| | |
| | |
|My T-Shirt Size is (circle) |
|S (8-10) M (12-14) L (16-18) XL (20-22) XXL (24-26) |
|RYLA SEMINAR CONTRACT |
| |
|I, ______________________________ will be 18 years of age at the start of RYLA. I agree to attend the RYLA Seminar and to abide by the seminar regulations, |
|including: |
|Travel by RYLA’s arranged Bus to/from the RYLA Seminar |
|Participate fully in the seminar 0600 – 2300 each day from Saturday 5 – Friday 11 May 2018 |
| |
|I will not seek any concession or non-attendance from any part of the program. |
|Leave: |WORKING? Ensure you have Leave approved |
| |STUDYING/UNI? Ensure study/exams are not during RYLA |
|Awardee Signature | Dated: |
|SPONSORING ROTARY CLUB INFORMATION |
|Rotary Club Of | |
|Club President Name & Signature | |
|Dated & Contact Phone Number | |
|Club Youth Director Name & Signature | |
|Dated & Contact Phone Number | |
| |
|NOMINATION FEE |$795.00 per participant if paid by 1/3/18 |
| |$850.00 per participant paid 2/3 – 3/4/18 |
| |Note: FEE IS NON REFUNDABLE |
| |DIRECT DEBIT: BSB 084 209 A/C No. 85-383-2749 (preferred) |
|PAYMENT: |REFERENCE: RYLA, Club & Surname of Rylarian |
| |CHEQUE: Rotary International D9600 Ltd |
| |Scan & Email Direct Debit receipt, application form & photos (preferred) - Post to below address |
|APPLICATION FORM: | |
|POST TO: |Bruce Lawton, RYLA Treasurer, PO Box 20 |
|EMAIL: |NAMBOUR QLD 4560 |
| |Ryla9600@ |
| | |
|CLOSING DATE: |FINAL APPLICATIONS – 3rd April, 2018 |
| |(Maybe earlier if we reach full capacity. Will advise all clubs via email) |
| |
|Should you have any enquires Please call |
|RLYA Chairman |Colleen Caruana |
|Mobile |0412 744 038 Email: c_caruana@ |
|RLYA Program Director |Greg Beard Email: greg.beard@.au |
|Mobile |0434 189 069 |
|RLYA Participant Coordinator |Ryan Hurley |
|Mobile |0433 371 631 Email: Ryanhurley180@ |
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DISTRICT 9600
Saturday 5 - Friday 11 May 2018
Luther Heights Youth Camp, Coolum Beach
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(Staple two (2) Passport size photo’s here) ??
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