registration

ROTARY INTERNATIONAL, 2005 TRI-DISTRICT CONVENTION

DISTRICTS 4110- 5470, 5520

REGISTRATION

1) Complete the form and Submit

2) Print the form and Fax it to: 505 393 3426

3) Print the form and send it to:

Rotary Tri-District Conference

P.O. Box 1444

Hobbs, NM 88241

USA

If you have any question/problem registering, please contact Suzan Holler : 1 (505) 392 4067

Personal Information

Name

Club

District

Classification

Preferred Badge Name

Address

City

State

Zip

Tel.

Fax

E-mail

Spouse Name

______________________________________________

Registration Fee: $80.00 US (per person)

Registration fee includes Dinners, Snack Breaks, Lunch and Home Hospitalities.

______________________________________________

Indicate Attendance #

$80.00 USD x

TOTAL

______________________________________________

Type of card

______________________________________________

Visa Mastercard

Card Number

Month

Year

Name on the card

The information on your form will be transferred manually to a secure database. However if you are not comfortable sending your credit card info on this form, please leave that field blank and send your check ahead of the conference at : Rotary Club of Hobbs, Rotary Tri-District Conference P.O. Box 1444 Hobbs, NM 88241

Please contact us if you have not received confirmation of your registration within 72 hours

This site is sponsored in part by the City of Hobbs Lodgers' Tax