Rotary Adventure Tour Application
Form to apply for the Rotary Adventure Eastern and Western Tour
Email address *
Your name as on your passport *
Your answer
What name do people call you? *
Your answer
Pick trips you want to take. *
Required
Your Cell Phone Number *
Your answer
Gender *
Birthday *
MM
/
DD
/
YYYY
Facebook Address (we communicate on FB) *
Your answer
Rotary District *
Your answer
District Chair Name & Phone Number *
Your answer
District Chair Email Address *
Your answer
Rotary Club and City *
Your answer
Club Counselor / Cell Phone *
Your answer
Your Country *
Your answer
Your Parents Name *
Your answer
Parent's Phone Number *
Your answer
Parents Address and Phone Number *
Your answer
I'd like to be a Team Leader (Student Leader) *
Allergies or food requirements *
Your answer
Your Hobbies and Interests *
Your answer
Your personality *
Your answer
Medical conditions and medications you take. *
Your answer
Rooming Request (1 person only) *
Your answer
Closest major airport to my host city. *
Your answer
I have read and understand the rules and conditions of this trip. You can see these on the Website. *
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