RYLA 2023 APPLICATION FORM
SATURDAY 24TH JUNE 2023 - SATURDAY 1ST JULY 2023
WILLOWPARK CONVENTION CENTRE - HOSTEL ACCESS ROAD, EASTERN BEACH
ryla9920@gmail.com 
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Email *
PERSONAL DETAILS
APPLICANTS ACCEPTED ONTO THE RYLA COURSE WILL BE INVITED TO A CLOSED FACEBOOK GROUP AHEAD OF THE COURSE TO RECEIVE UPDATES AND IMPORTANT INFORMATION.
Surname *
Given Name (s) *
Preferred Name *
Address *
Town / City *
Mobile Phone *
Email address (Work) *
Facebook Email (if different from above) *
Date of Birth *
MM
/
DD
/
YYYY
Sex (M/F) *
Required
Shirt Size *
Required
Shirt Size *
Required
Dietary Restrictions (Medical and Religious only) *
Have you already been interviewed to attend RYLA 2023 *
If yes were you interviewed by *
Which Rotary Club / Rotarian has interviewed you for RYLA 2023?
Which workplace has interviewed you for RYLA 2023
EMERGENCY CONTACT INFORMATION
PLEASE PROVIDE DETAILS OF WHO TO CONTACT IN THE UNLIKELY EVENT OF AN EMERGENCY
Contact Name *
Relationship to applicant (e.g Mother) *
Address *
Town / City *
Home Phone (emergency contact) *
Business Phone (emergency contact) *
Mobile phone (emergency contact) *
HEALTH & FITNESS (This section must be fully completed)
FOR THE SAFETY OF ALL CANDIDATES, ALL MEDICATION MUST BE DISCLOSED TO THE RYLA ORGANIZING COMMITTEE, THIS INFORMATION WILL REMAIN CONFIDENTIAL AND ONLY SHARED WITH MEDICAL STAFF RELEVANT TO THE PROGRAM, EDIT THIS IS NOT CORRECT YET
Fitness Level *
Fitness Activity *
Required
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