2018 District Interact & Earlyact Conference

Sunday 11th March 2018 from 8:30am to 3:00pm

St Columban’s College, Caboolture

Conference Registration Form

Please RSVP by Wednesday, 21st February 2018by forwarding this registration

with payment to:

Rotary International District 9600 Ltd.

Email:

Postal: PO Box 20, Nambour QLD 4560

Delegate Details
Surname: / First Name:
Home Address: / Male/Female: / Age:
Post Code: / Email Address:
Delegate category (Please tick): / Interact Student / Earlyact Student
Teacher/Supervisor / Rotarian
Parental Permission and Emergency Contact Information: (for Interact & Earlyact students)
Parent/Guardian Name:
Home Phone: / Mobile Phone:
I give permission for my son/daughter to attend The District Interact & Earlyact Conference on Sunday, 11th March 2018
My son/daughter is able to have their photo reproduced in Interact publications. / Yes
No
Signature: / Date:
Special Requests
Dietary: / Wheelchair:
Allergies:
Do you have an epipen? Y/N
If ‘Y’, please talk to staff on arrival so they can be aware of where you keep it. / Shuttle service from Railway Station to
St Columban’s
Required/not required (circle chosen option)
School and Club Details
School: / Teacher/Staff Member:
Position in Interact/Earlyact (if any): / Year Level:
Sponsoring Rotary Club: / Rotarian Adviser:
Teachers, please respond to the following questions:
Will your club be preparing a PowerPoint presentation for the Conference? / Yes
No
What is the best mailing address for your club?
What is the best email address for your club?
What is the best phone contact for your club?
Payment Options:
The Registration fee of $15-50 per person may be paid by (please tick payment option):
Please note that your sponsoring Rotary Club may be approached to cover this cost
Cheque to:- PO Box 20 Nambour 4560
Direct Credit
  • Cheque: Make out to ‘Rotary International District 9600 Limited [and attach to this form].

If you pay by direct credit, you must let me know that it has been paid!
If your Rotary Club or school requires an invoice, email:- .
  • Direct Deposit: Please transfer $15-50 for each attendee to:
Account Name: / Rotary International District 9600 Limited
Account No. / 853832749 / Branch Name / Virginia
Bank / NAB / Branch No. (BSB) / 084209
NB. Please include the school or your name with‘INTor ‘EARL’to identify the transfer!
Please also email the payment information to Jan Lawton
This avoids confusion of payment for each school & or Rotary member attending
Receipt sent when requested!