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Personal Information

• * First Name:
• * Last Name:
• * Email Address:
• * Confirm Email Address:
• * Phone:
• * Address 1:
• Address 2:
• * City:
• * State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• * ZIP Code:
• * Club Name:
• *

  Rotary District:

  • 7890 (Northern Connecticut and Western Massachusetts)
  • 7950 (Rhode Island, Southeast Mass. Cape & Islands)

• Fee

  Type	Fee
  Event fee	$25.00

• *

  I consent to being recorded during the virtual conference.

  • Yes
  • No

Which conference activities do you plan on attending?

• *

  Thursday, April 29, 6:15 PM - 8:45 PM. Please select all activities you will attend; choose only one from simultaneous Sessions 1A, 1B or 1C. For speaker information, refer to the event schedule.

  • Keynote Speaker, So When Will We Eradicate Polio? PDG Mike McGovern
  • -----Session 1A: Moving from Diversity to Inclusion
  • -----Session 1B: Branding, Public Relations, Marketing
  • -----Session 1C: 7th Area of Focus, Human Impact on the Environment
  • Digital Hospitality Suites and Fellowship
  • I will not be able to attend on Thursday night.
• *

  Friday, April 30, 6:15 PM-9:00 PM- Select all activities you are interested in attending.

  • Keynote Speaker, RI Director Valarie Wafer, D7010
  • Trivia-Fun and Interactive!
  • I will not be able to attend on Friday night.
• *

  Saturday, May 1st, 8:45 AM - 11:30 AM. Please select all activities you will attend; choose only one from simultaneous Sessions 2A, 2B, 2C and 3A, 3B, 3C. For speaker information, refer to the event schedule.

  • ---Session 2A: Peace Fellowship Strategies as a Police Officer: Its Impact and Value
  • ---Session 2B: The Rotary Foundation: What You Always Wanted to Know But Were Afraid to Ask
  • ---Session 2C: Service Projects, Share your community and international service projects.
  • ***Session 3A: Let’s Grow Your Rotary Club’s Membership!
  • ***Session 3B: Rotary’s Youth Programs – Seizing the Future
  • ***Session 3C: Fundraising in a Pandemic!
  • I will not be able to attend on Saturday morning.