Rotary Youth Leadership Academy: Club Confirmation Form

Club Registration Form

Rotary Youth Leadership Academy
Club Name*
Club Liaison:*

First Name Last Name
Club Liaison E-mail:*
Number of candidates we will send:*

1 delegate2 delegates3 delegates1 or 2 or 3 delegates (not sure)
We agree to the following...*

We have read and understood the Club Checklist including the stipulated deadlines. We also agree to provide payment of $300 Canadian ($250 U.S.) for each delegate we send to the RYLA program. Please pay by credit card on the District Website noting payment is for RYLA or by cheque or by e-transfer (see directions to each on the RYLA site)
Should be Empty:

Club Registration Form