Rotary Members Registration Form

PLEASE FILL THE BELOW FORM

Primary Participant

Country

Select Category Type
Rotarian Rotaractor Interact

First Name :

Family Name:

Club Name:

Call Name
(For Badge)

Gender :
Male Female

Contact No :

Mobile No :

Office No :

Fax No :

Email Id :

Profession :

Spouse, Family Member , Friend

Select Category Type
Rotarian Rotaractor Non-Rotarian

First Name :

Family Name:

Club Name:

Call Name
(For Badge)

Rotary Title

Gender :
Male Female

Contact No :

Mobile No :

Office No :

Fax No :

Email Id :

Profession :

Guest Family Name :

First Name:

Call Name: (Call Name For Badge)

Registration Fees	Early Bird Offer Till December 2020	January 2021 To March 2021	Number of Persons	Amount in USD
Rotarian :	USD 400	USD 500		USD 400
Spouse & Guest :	USD 400	USD 500
Rotaractor & Interact :	USD 200	USD 200
Paul Harris Fundraiser Event :	USD 100	USD 100
Registration Package: Welcome Kit - Opening Ceremony - Coffee Break - Lunch & Dinners . Reset Selection

Total Registration Fees (in USD)

USD 400

Choose Payment Option :
Credit Card

By signing this form I confirm that I have read and accepted the cancellation policy .

For more information kindly visit www.rotaryd2452.org Please return the form duly filled to email info@prince.events

Rotary International 8thDistrict 2452 Conference Manama, Bahrain 11th to 14th March 2021 REGISTRATION FORM