23rd Annual Rotary Club of Pittsford Trout Derby Registration Form May 18, 2019
For Kids 15 years old or younger
Email address *
Participant 1's Name: *
Your answer
Participant 1's Age: *
Your answer
Participant 2's Name:
Your answer
Participant 2's Age:
Your answer
Participant 3's Name:
Your answer
Participant 3's Age:
Your answer
How did you hear about us?
Parent/Guardian Name: *
Your answer
Phone Number:
Your answer
Street Address:
Your answer
City, State & ZIP:
Your answer
Is this your first Rotary Derby?
Would you like to be advised of future Rotary Events?
I hereby authorize the Rotary Club of Pittsford or anyone they authorize to use photographs taken for advertising, display, competition, education and publication in all manners for any product or services, or other lawful uses as determined by the Rotary Club of Pittsford. I further waive any and all rights to review or approve any uses of the images, any written copy or finished product. I have read and fully understand the terms of this release.
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