Official Use Only:
Registration Number: / Date Received: / /
Main Registrant Data:
First Name: / Last Name: / Badge Call Name:
Male  Female  / Rotary Club of: / District: Zone:
Rotarian  / Country: / Mobile:
Passport No.: / Passport Validity date: / Passport Issuing Country
Rotary Position (current): / Email: / Emergency Mobile:
Spouse Data:
First Name: / Last Name: / Badge Call Name:
Male  Female  / Rotary Club of: / District: Zone:
Rotarian  / Country: / Mobile:
Passport No.: / Passport Validity date: / Passport Issuing Country:
Guest Data:
First Name: / Last Name: / Badge Call Name:
Male  Female  / Rotary Club of: / District: Zone:
Rotarian  / Country: / Mobile:
Passport No.: / Passport Validity date: / Passport Issuing Country:
HOTEL ACCOMMODATION:"Prices include all taxes and service charges"
Hotels / Single
(per night) / No. of Rooms / Double
(per night) / No. of Rooms / No. of Nights / Total
1. Art Rotana Al
Amwaj
(venue hotel) / EURO 135/-
(Breakfast Included) / EURO 155/-
(Breakfast Included) / EURO
2. The Grove Hotel &
Conference Centre / EURO 110/-
(Breakfast Included) / EURO 120/-
(Breakfast Included) / EURO
3. Ramada Hotel &
Suits Amwaj Islands / EURO 70/-
(Breakfast Included) / EURO 85/-
(Breakfast Included) / EURO

PLEASE FAX THE FILLED & SIGNED FORM TO FAX NO.: +973 1774 1070

ALONG WITH A COPY OF YOUR PASSPORT FOR VISA PURPOSE (IF REQUIRED)

Page 1 of 2

REGISTRATION:"Prices include all taxes and service charges" / 3 Days Package for RotariansPer Person / 3 Days Package Spouse / Guest
Per Person / 2 Days Package for Rotarians Per Person / Total
Registration Fees: / EURO 60/- / EURO 10/- / EURO 60/-
Event charges(Opening/Cocktail on 18 March; Lunch with 2 Coffee breaks on 19, 20 & 21 March; Dinner on 19 & 20 March; Gala Dinner on 21 March 2018) / EURO 340/- / EURO 340/- / EURO 230/-
* REGISTRATION TOTAL: / EURO
CREDIT CARD PAYMENT:
* REGISTRATION TOTAL: / EURO
ADD ADVANCE PAYMENT FOR HOTEL ACCOMODATION RESERVATION:
(Hotel Accommodation due balance to be paid personally during check-in) / EURO 100.00
TOTAL AMOUNT TO BE CHARGED TO YOUR CREDIT CARD: / EURO
TRAVEL DETAILS:
Arrival Date: / Arriving From: / Flight No.: / Arrival Time:
Departure Date: / Departing To: / Flight No.: / Departure Time:
CREDIT CARD AUTHORIZATION:
Card Type: / MasterCard  Visa 
Card Holder Name
(as shown on card)
Card Number:
CVV: / Card Expiration Date:
Total Amount To Charge on CC: / EURO
Cardholder E-mail:
Cardholder Address:
Credit Cardholder Signature: ………………………………………………………………………………………………………………………
CANCELLATIONS: No charges prior to 72 hours of the event date (excluding bank charges).
PLEASE FAX THE FILLED & SIGNED FORM TO FAX NO.: +973 1774 1070
ALONG WITH A COPY OF YOUR PASSPORT FOR VISA PURPOSE (IF REQUIRED)

Page 2 of 2

Manama, Kingdom of Bahrain, E-mail: , Tel.: +973 17741040; Fax: +973 17741070