Course Day – December 7, 2019

Date: Saturday, December 7, 2019

Fee: $20.00 per person payable via credit card or Paypal account using this form. Fee is non-refundable unless event or course is cancelled.

Location:
Ramada Inn and Conference Center
100 Ramada Inn Drive
Greensburg, PA 15601


Course Selection (required):
THIS IS A GRADUATE COURSE ONLY. You must have taken Parts I, II, and III to be eligible to take this course.
Graduate

Interested in Faculty Training/Re-Training on Friday evening:
YesNo

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 ($20.00) is non-refundable unless event or course cancelled.

I Agree To and Accept Terms and Conditions