Rotary Youth Leadership Awards Conference

Please complete and return with payment by April 15. All fields are required. The Rotary Club wishes to reserve a space for students at the District's Rotary Youth Leadership Awards Conference in September at Camp Manito-wish YMCA in Boulder Junction, WI. We are enclosing a check for $ to cover the participant fees ($225.00 per participant). We understand that no refund will be returned to our club in the event a student does not attend the conference unless the District RYLA Chairperson is notified at least 2 weeks before the start of the conference. Personal Information:
Rotary Club Contact :
Address:
City:
State:
ZIP:
Home Phone:
Business Phone:
E-mail Address:
Date:	(mm/dd/yyyy)

Please make check payable to:
Rotary Youth Leadership District 6220
C/o Thom Cody
4696 Golden Pond Park Court, Suite 100
Oneida, WI 54155