2024 RYLA University Participant Reservations (Filled Out by Rotary Club)
Rotary Clubs fill out this form before May 15, 2024
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Which Rotary Club are you representing? *
What is your position in your Rotary Club? *
Your First Name: *
Your Last Name: *
Your Mobile Phone Number: *
Your Home Phone Number:
Your Email Address: *
Mailing Address for Your Rotary Club: *
How many participants are you reserving spots for? *
Please list First Name, Last Name, High School and Email Address (NOT SCHOOL EMAIL) for each participant you are registering:

We also encourage you to select at least one alternate participant that would be able to attend the program in the event that one or more of your selected participants have a change of plans and cannot attend the program. Please identify which participants are alternates.
I acknowledge and understand that a scholarship is not reserved for RYLA University until the scholarship is fully funded. The registration deadline is May 17, 2024.

Scholarships are $475 if paid before April 30, 2024 and $500 after that. Write out a check payable to Rotary District 7475 for the correct amount of scholarship funds. Note “RYLA 2024” on the check. Mail the check to District Treasurer Judith Frank, 17 Condit Street,
Succasunna, NJ 07876.
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