Registration

A payment link will appear on the confirmation page where you will be redirected after you click SUBMIT at the bottom of this page/form. You will also receive an email confirmation with the information you have submitted on this form. If you are not redirected to a confirmation page, or don't receive your confirmation email, please contact registrar@district5030conference2009.org .

YOU WILL MAKE YOUR CREDIT CARD PAYMENT ON THE NEXT PAGE.

If you have already registered, and would like to add a trip on the Victoria Clipper to travel to Victoria, or if you would like update the sailings you are registered to travel on, please click here.

* Indicates required fields.

First Name of Rotarian*

Last Name of Rotarian*

Nickname

The nickname will appear on your name tag.

Rotary Club of

or other:

Email*

Address

City

State

Zip/Postal Code

Country

Phone

Fax

Names of guests or additional rotarians
(for additional rotarians, please list the rotarian's club)

Diet/Disability Needs (indicate which person):

Please specify

Select all that apply:

Rotarian
Name:

PH Society
PH Fellow
Major Donor
Benefactor
District Gov
Past Dist Gov
Assist Gov
Club Pres
Past Pres
Pres Elect
Conf Comm
First Timer
New Member

2nd Rotarian/Partner/Guest
Name:

PH Society
PH Fellow
Major Donor
Benefactor
District Gov
Past Dist Gov
Assist Gov
Club Pres
Past Pres
Pres Elect
Conf Comm
First Timer
New Member

Additional past honors or positions that we should be aware of

Travel Arrangements

Special arrangements have been made with the Victoria Clipper for Rotarians attending this district conference. The cost will be $119.00 (U.S. Dollars) for the round trip. It is important that you sign up for specific vessel departures as three of the boats will be for Rotary only and we will need to make sure everyone and their luggage get on the right boat.

If you would like to travel to Victoria on the Clipper, please check this box and select the departures that you would like below.

Seattle Departures	Depart	Arrive
April 29, 2009 Wednesday	8:00 A.M.	10:45 A.M.
April 30, 2009 Thursday	8:00 A.M.	10:45 A.M.
May 1, 2009 Friday*	8:30 A.M.	11:15 A.M.
Victoria Departures	Depart	Arrive
May 3, 2009 Sunday	11:30 A.M.	3:15 P.M.
May 3, 2009 Sunday*	12:00 P.M.	3:30 P.M.
May 3, 2009 Sunday	6:00 P.M.	8:45 P.M.
May 4, 2009 Monday	11:30 A.M.	3:15 P.M.
May 5, 2009 Tuesday	11:30 A.M.	3:15 P.M.
May 6, 2009 Wednesday	11:30 A.M.	3:15 P.M.
*Rotary Charters

Number Traveling on the Clipper

TOTAL # ADULT REGISTRANTS

$275.00 (U.S. Dollars) per person

TOTAL # CHILDREN UNDER 12

$185.00 (U.S. Dollars) per person for children under 12

YOU WILL MAKE YOUR CREDIT CARD
PAYMENT ON THE NEXT PAGE.
A payment link will appear on the confirmation page that you will be redirected to after you click SUBMIT. You will also receive an email confirmation with the information you have submitted on this form.