Salem Convention Center • 200 Commercial Street SE • Salem, Oregon 97301

2018 DISTRICT 5100 CONFERENCE

REGISTRATION FORM

Great food, great music, great speakers and a great way to celebrate Rotary!

LODGING – Special Rotary rates are available at the beautiful Grand Hotel adjacent to the Convention Center. Book your room prior to April 1, 2018 to receive these special per night rates. Room availability and rates not guaranteed after this date.

Deluxe King
Deluxe Double Queen
Suite King
Suite Double Queen / $134
$144
$154
$164 / To make hotel reservations, call the Grand Hotel directly at 503-540-7800 or
877-540-7800 (toll-free) and ask for the Rotary Conference rates, Thursday May 17, 2018 to Sunday May 20, 2018. If you would like to extend your stay in Salem, these group rates will be offered for the 2 days prior and/or post conference.

REGISTRANT: Please select your registration designation. All Rotarians must register individually.

 Rotarian Guest  Conference Speaker

 Parent of 4-Way Test Contestant  Rotarian Guest (Other District)

SPECIAL NEEDS:

 Mobility Access Special Food Needs ______

(pleasespecify)

Name: / Nickname for Badge:
Address:
City, State, ZIP:
Telephone: / Spouse/Partner Name for Badge:
Email Address:
Guest Name for Badge: / Guest Name for Badge:

CONFERENCE REGISTRATION–Please make your meal and tour selections from the list on the back. There is no conference fee, only charges for the selected meals and special tour events. When you sign up for lunches, you are entitled to attend all events of the day, up until dinner. For those registered to stay in the hotel, all breakfasts are included in your room rate.

Meals / Activities / Cost / Number of Attendees / Total
Registrant / Spouse/
Partner / Guest(s)
PRE-CONFERENCE EVENT
Youth Exchange Barbecue: Thursday, 6-8pm, Rotary Pavilion, Salem Riverfront Park / Free
TOUR/EVENTS
Community Service Project(s) Sign up at event / Free
Excursion(s) Sign up at event / Free
Major Donor, Bequest Society, Paul Harris Society Reception: Saturday, May 19, 5:00-6:00pm, by invitation / n/a
MEALS
Friday Lunch: Buffet / $30
Friday Dinner & Youth Exchange Talent Show: Salad, dessert and your choice of entrée:
 Chicken  Vegetarian / $50
Saturday Lunch: Buffet / $30
Saturday District Governor’s Banquet: Salad, dessert and your choice of entrée:
 Surf & Turf  Vegetarian / $50

Payment Options: Payment information must accompany all registration forms and be received in the District 5100 Rotary office by May 14, 2018 at 12:00 Noon

  1. Register Online: Login at

Click the Calendar tab. Scroll to the event and click Register. Thank you for using this option!!

  1. Print and mail registration with check or credit card information to:

Rotary District 5100

ATTN: District Conference

6700 SW 105th Avenue, Suite 314

Beaverton, OR 97008

Credit Card:  Visa Mastercard

#______Security Code_____ Exp: _____/_____

IMPORTANT! THIS IS A MAIL-ONLY FORM.

DO NOT EMAIL THIS FORM IF IT CONTAINS YOUR CREDIT OR DEBIT CARD NUMBER!

Registration Questions: Please contact Registrar, Kelly

Refund/Cancellation Policy:Refund requests must be sent in writing to the Rotary District 5100 office via mail, fax, or email. Refunds will not be granted by phone. Rotary District 5100 will make a full refund for any request received 10 business days before scheduled start of any event. Any cancellation received 5-9 business days prior to start will receive 50% refund. No refunds on cancellations less than 5 days before the scheduled start of an event.In the event attendees have not pre-registered and paid for an event,attendees will be required to pay at the door by cash, credit card, or check.Clubs may pre-pay for their members’ attendance – either through DACdb or by submitting a list of their Club’s attendees and payment – no less than 5 business days prior to the event start.For more information regarding refund and registration policy, please contact the Rotary district 5100 office at503-605-5100.