Course Day – March 9, 2019

Date: Saturday, March 9, 2019

Fee: $75.00 per person payable via credit card or Paypal account using this form. Fee is non-refundable unless event or course is cancelled.

Saints Gregory & Barnabus Church
120 Boltz Street
Johnstown, PA

Course Selection (required):
You can only take one part and they must be taken in order (i.e., Part I before Part II).
Part IPart IIPart IIIGraduate

Your Full Name (required):

Your Badge Name (required):
The name you want others to call you (i.e., your first name).

Your Address (required):

Your City (required):

Your State (required):

Your Zip (required):

Best Telephone Number to Reach You (required):

Your Email (required):

Your Rotary Club (required):

Your District Number (required):

Years in Rotary (required):

Special Dietary Needs (required):
We will contact you if "Yes". NoYes

Terms and Conditions (required):
Registration fee ($75.00) is non-refundable unless event or course cancelled.

I Agree To and Accept Terms and Conditions