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District 6200 Mid-Year Assembly - Registration Form

RI DISTRICT 6200 DISTRICT ASSEMBLY
Saturday, May 8, 2010
8:00AM - 12:00 Noon
Clifton Chenier Center, Lafayette, Louisiana

PARTICIPANTS:
2009-10 Club Presidents, Club President Elects (2010-11), 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:
09-10 Club President
10-11 Club President
Club Secretary Elect
Club Treasurer Elect
Club Committy Chair
Past District Governor
District Governor

District Governor Elect
District Governor Nominee
District Governor Nominee Designate
Assistant Governor
Assistant Governor Elect
District Secretary
Other (DGN, Club Member, etc.)