Rotary Youth Leadership Awards 2017

ROTARY YOUTH LEADERSHIP AWARDS 2017 E-mail [email protected] • Fax (907) 452-6853 • Web www.RYLA5010.org Mail: RYLA Registrar ● 1606 Heather Drive ● Fairbanks, AK 99709 ** All checks need to be mailed to the RYLA Registrar at the address above ** RYLA 2017 - CLUB COMMITMENT FORM PLEASE FILL OUT & RETURN WITH YOUR CLUB PAYMENT BY March 1, 2017

1. CONTACT INFORMATION NAME ADDRESS PHONE E-MAIL PLEASE PRINT First and Last Name Please Please include zip code! Please indicate Home, Please indicate Home or Cell, & or Work Work & how often you check it YOUR ROTARY CLUB

PRESIDENT

RYLA REP

2. WHAT IS THE BEST WAY TO REACH YOU? ______

3. WHAT IS THE BEST DAY/TIME TO REACH YOU? ______

4. WHAT IS THE BEST DAY/TIME FOR A TELECONFERENCE OR MEETING? ______

Number of People Type of Fee Cost

Registration Fee: Youth Leader Participants $325/participant (US$) Registration Fee: Rotarian Chaperone $100/chaperone (US$) total Transportation Fee (based on formula below) $____/person (US$)

TOTAL CLUB COST Transportation Cost: ****Transportation to Fairbanks, AK is to be arranged by each club/chaperones**** 5. MY SIGNATURE BELOW STATES THAT I HAVE READ AND UNDERSTAND: □ The Club Commitment Form will be mailed, faxed or emailed by January 31, 2017 to 907-452-6853 or [email protected] □ The Registration Fee of $325 per Youth Leader and $100 per Rotarian Chaperone will be included with the previously faxed Club Commitment Form and mailed by March 1, 2017. You can also register and pay for your students/chaperone online by going to the District Website, www.rotary5010.org under Quick Links - RYLA 2017 – Forms and Information. □ Checks should be made payable to: District 5010 RYLA and mailed to RYLA Registrar ● 1606 Heather Drive ● Fairbanks, AK 99709. If not on the check itself, please put your Rotary Club Name on the memo line. □ My Club will also be forwarding copies of the Transportation Arrangements to the RYLA 2017 Committee, for coordination purposes, as soon as possible, but no later than March 15, 2017. Clubs will pay and coordinate participant’s transportation costs to Fairbanks. □ My Club understands that RYLA is at Pike’s Waterfront Lodge in Fairbanks, AK, March 23-26, 2017 and the youth must have a government issued photo ID (i.e. driver’s license or government issued photo ID card). Canadian clubs will need youth to have a passport and a letter signed by both parents authorizing the youth to travel across the Canadian/US border to attend the event.

SIGNATURE - 2017 Club RYLA Representative DATE