DC_Interact Registration

Registration due by March 3, 2025

Interact Club of*

Interact Club Contact Name*

Interact Club Contact’s email*

Rotary Club Contact Name*

Rotary Club Contact’s email*

# of Interact members attending*

# of Chaperones attending*

X $10.00 = (# Interact + Chaperone x $10)

Please select Transportation option to/from the District Conference

School BusOther

Please list # of meals by dietary restriction: (Example: # gluten-free, # dairy-free, # vegetarian/dairy-free, etc.)

NOTE: Each Interact Club member attending will need to complete and sign the Student Participation Form attachment with their payment.

Any questions, please contact:

Michael Williams - mdub0308@gmail.com or

Checks payable to:

Rotary District 7570 Conference
c/o Lydia Heatwole, District Conference Treasurer
3000 Claybrook Ct
Rockingham, VA 22801