Rotary Youth to Youth Application Form

October 8-11, 2021
  • Your Personal Information

  • Enter Your Date of Birth
  • Enter your age
  • Email Address
  • Parent/Guardian Information

  • More about You:

  • Reference:

    Please provide the name and contact information for someone we can contact to find out more about you – a teacher or someone you work with, etc. (not a friend or family member):
  • Other Details

  • Unknown at this time, leave blank but please let us know as soon as you find out.
  • Unknown at this time, leave blank but please let us know as soon as you find out.
  • Unknown at this time, leave blank but please let us know as soon as you find out.
  • Consent and Terms and Conditions

  • Sponsorship

    I am aware that there is a cost to attend the programme which is included in the information package. Some, or all, of the cost might be covered for you by sponsorship. We would like to know the following: