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iRYLA Registration
Please choose your participation role.
Please Select
Team Leader (Adult Leaders, 21+)
Junior Team Leader (Former RYLA Participants)
Participant (High School Student)
Instructor
Observer
If the following questions do not apply to your role (Instructor/Team Leaders/Observers), you may leave it blank.
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Date
-
Month
-
Day
Year
Date
Are you an Interactor?
Yes
No
No, but I want to be.
What's that?
Sponsoring Club
Please Select
Bardstown
Bedford
Bowling Green
Bowling Green AM
Brandenburg
Cadiz
Campbellsville
Carollton
Clinton
Columbia
Danville
Daviess County
Dawson Springs
East Louisville Sunrise
Elizabethtown
Elkton
Eminence
Frankfort
Franklin
Fulton
Glasgow
Grayson County
Greensburg
Hardin County A.M.
Hardin County Sunset
Hardinsburg
Harrodsburg
Henderson
Hickman
Hodgenville
Hopkinsville
Horse Cave
LaGrange
Lawrenceburg
Lebanon
Rotary Club of Louisville
Louisville Suburban
Madisonville
Marshall County
Mayfield
Muhlenburg Count
Murray
Owensboro
Owenton
Paducah
Princeton
Prospect/Goshen
Radcliff
Russellville
Scottsville
Shelbyville
South Oldham
Southwest Louisville
Springfield
Union County
* Interactors - if you know which Rotary Club sponsors your club, you can enter it here. If you're unsure, you may leave it blank.
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Age
* Team Leaders, Instructors, Observers do not need to fill this out.
Gender
Male
Female
Other
Email
Confirmation Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone Number
Please enter a valid phone number.
Current Grade
* Team Leaders & Instructors do not need to fill this out.
Name of High School
* Team Leaders & Instructors do not need to fill this out.
Graduation Year
* Team Leaders & Instructors do not need to fill this out.
T-Shirt Size (Adult Sizes)
Please Select
Small
Medium
Large
X-Large
*Instructors do not need to fill this out.
Submit
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