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RYLA 7490 2023 Participant Registration Form - For Rotarians to Fill Out
Participant Registration for RYLA 2023 is due ASAP.
One form must be filled out for each individual participant.
Please visit RYLA7490.org/info and/or email TeamRYLA7490@gmail.com with any questions.
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* Indicates required question
Email
*
Your email
I am registering a:
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Main Participant
Alternate Participant
Sponsoring Rotary Club
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Your answer
Rotarian's First Name
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Your answer
Rotarian's Last Name
*
Your answer
Rotarian's Email Address
*
Your answer
Rotarian's Phone Number
*
Your answer
Rotarian's/Rotary Club's Mailing Address
*
Your answer
Participant's First Name
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Your answer
Participant's Last Name
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Your answer
Participant's Sex Assigned at Birth
*
Choose
Male
Female
Other
Prefer not to disclose
Participant's Birthdate
MM
/
DD
/
YYYY
Participant's High School
*
Your answer
Participant's Email Address (NOT school email)
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Your answer
Participant's Phone Number (Preferably His or Her Personal Mobile Number, if Applicable)
*
Your answer
Interact Advisor's Name (Leave Blank if Not Applicable)
Your answer
Participant's T-Shirt Size (if not entered, participant may receive a t-shirt that is not their correct size)
Choose
S
M
L
XL
XXL
Interact Advisor's Email Address (Leave Blank if Not Applicable)
Your answer
Participant's Parent's/Guardian's Email Address
*
Your answer
Participant's Parent's/Guardian's Phone Number
*
Your answer
Scholarship Funds for This Participant:
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Have Already Been Sent
Have Yet to Be Sent
RYLA participant registration is not confirmed until this form has been filled out for the participant and scholarship funds are received by RYLA 7490. Checks may be written out to "Rotary District 7490 - RYLA" and mailed to District Treasurer Dawn Marcano at 15 Mary Street, Lodi, NJ 07644. There are no refunds. If a participant is not able to attend RYLA for any reason or no reason at all, RYLA 7490 will use the scholarship funds for that participant to help fund other participants or aspects of the program. We recommend that your Club keeps one or more alternate participants in mind that would participate in place of this participant should the participant not be able to attend the program. Participants must attend the entirety of the program without interruptions. For more information, visit
www.RYLA7490.org/info
and/or email TeamRYLA7490@gmail.com.
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