Privacy statement: the information collected during registration will not be shared with any third party.
* = Required Field

Rotarian

*First Name:

*Last Name:

Badge Name:

*Club:

*Address:

*City:

*State:

*Zipcode:

*Phone (day):

Phone (eve):

*Email:

Spouse/Guest

First Name:

Last Name:

Badge Name:

Club:

Registration and Meal Options

Registration is available as a package price, or Sat Dinner only. The package price includes
the "An Evening with Mia Farrow (Sat Dinner)". Check the corresponding boxes below.

 

Price
(each)

Rotarian

Spouse/
Guest

Full Conference Package
(includes registration and all meals)

$250

An Evening with Mia Farrow (Sat Dinner)

$150

Saturday Breakout Sessions

If you've registered for the Full Conference Package, please signup for the breakout sessions. This will help us to determine the size of the room needed. You can always decide to attend other sessions later.
Session 1 is from 9 to 9:50 am., Session 2 is from 10 to 10:50 am., Session 3 is from 11 to 11:50 am.
The "USD Peace Center Field Trip" takes all sessions.

Session 1:    Session 2:
Session 3:

Confirmation and Payment

When submitting this form, you will see a confirmation screen with the calculation of the Conference fee, and you will be able to pay online. Payment may also be sent by mail. Registration will not be complete until you select a payment option.

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