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RYLA 2009
PERSONAL INFORMATION
Full Name:
Street Address:
City: State: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip Code:
Email Address :
Contact Number:
Rotaract Club Rotaract Club of Annapolis Rotaract Club of Baltimore Rotaract Club of Capitol City-Washington, DC Rotaract Club of Capitol Hill-Washington, DC Rotaract Club of Cecil County Rotaract Club of Downtown Washington, DC Rotaract Club of Frederick Community College Rotaract Club of Frederick Success Rotaract Club of Hartford, Connecticut Rotaract Club of Hood College Rotaract Club of Howard County Rotaract Club of Loyola College Rotaract Club of Montgomery College-Rockville Rotaract Club of Montgomery College-Takoma Park Rotaract Club of Prince George’s County Rotaract Club of St. Mary’s College Rotaract Club of Towsontowne Rotaract Club of University Maryland-College Park Rotaract Club of Virginia Tech Rotaract Club of Washington, DC Other
Position: 2008-2009 Rotary Year (Select All that Apply)
President
Vice President
Secretary
Treasurer
Sgt-of-Arms
Director of Professional Development
Director of International Service
Director of Community Service
Director of Club Service
Director of Fundraising
Director of Social Activities
Director of Public Relations
Director of Programs
Director of Youth Activites
Director of Web Development
Student Senate
Historian
Rotary Liason
Past President
Past President/DRR
Past President/Past DRR
Past Board Member (Please Specify)
Other
Member
Rotaract Member Since:
Did you attend RYLA 2008 in District 7620? No Yes
As a Rotaractor, how many times have you attended RYLA in District 7620? 8 7 6 5 4 3 2 1 0
As a Rotaractor, have you attended RYLA in another Rotary District? No Yes
If yes, where?
Did you attend RYLA while in high school in District 7620? No Yes
If yes, how many times? 3 2 1 0
All Rotaractors must attend one of the two following group interviews: Saturday (November 1) 2pm at the University Maryland-College Park. Saturday (December 6) 2pm at the University Maryland-College Park.
(NOTE: Upon submitting your form, you will be contacted with a specific time for that particular day).
Badge Name:
Gender: Male Female
Age: Under 21 Over 21
T-Shirt Size: S M L XL XXL
Food Choice: Vegetarian Non-Vegetarian
Are you interested in being a “Judge” for the Talent Show, Mascot Presentation or Sharefair? No Yes
(You will be informed by District 7620 RYLA-Rotaract Chair if you will be judging any of the above during the 1st week of February).
Name:
Relationship: Contact Number:
Upon hitting the submit button, your name will appear in the "Who's Attending" list within 3-4 days.