A payment link will appear on the confirmation page where you will be redirected after you click SUBMIT at the bottom of this page/form. You will also receive an email confirmation with the information you have submitted on this form. If you are not redirected to a confirmation page, or don't receive your confirmation email, please contact distconfreg@rotary5030.org.
YOU WILL MAKE YOUR CREDIT CARD PAYMENT ON THE NEXT PAGE.

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The nickname will appear on your name tag.
Rotary Club of
Diet/Disability Needs (indicate ):
        

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2nd Rotarian/Partner/Guest
TOTAL # REGISTRANTS

$250.00 per person
TOTAL AMOUNT DUE $