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District 6200 Mid-Year Assembly - Registration Form

DISTRICT 6200 DISTRICT MID-YEAR ASSEMBLY
Saturday, January 21, 2012
Lafayette Parish Library ~ Southside Branch 6101 Johnston St., Lafayette, LA

PARTICIPANTS:
2011-12 Club Presidents, Club Presidents-Elect (2012-13), and members of Rotary Clubs assigned by the Club President-Elect to serve in key leadership roles in the upcoming Rotary year related to membership, public relations and service projects.


Download Printable Form - PDF Version

PLEASE PROVIDE ALL THE INFORMATION BELOW:

Registrant Name:
Name for Badge:
Rotary Club:
Phone:
Address:
President
President-Elect
Past District Governor
District Governor Committee Chair
Club Secretary/Treasurer
Club Newsletter Editor
Club Committy Chair

District Governor Elect
District Governor Nominee
Assistant Governor
Club Program Chair
Club Foundation Chair
Other (DGN, Club Member, etc.)