Untitled Document

I. BASIC DATA

Full Name:

Badge Name:

Sex:

Male
Female

Size:

Small
Medium
Large

Rotaract Club of:

Country:

District:

Non-Rotaractor:

     Rotarian
     Interact
     others

If Fellow in service, please specify club name:

Phone

Fax

Mobile

E-mail

Address:

II. UP CLOSE AND PERSONAL DATA

Specialization

Do you play any musical instrument?

Yes
No

If yes, please specify

Do you play basketball or football?

Yes
No

If yes, please specify

Do you have special artistic talents?

Yes
No

If yes, please specify

Do you have other talents that you can perform in public?

Yes No

If yes, please specify

Do you have any health problems?

Yes No

If yes, please specify

In your opinion, what is the best way to help LEBANON?

III. ATTENDANCE

FULL program ($250)
Partial Program (Packages)

IV. ACCOMODATION

Preference for:

Double
      preferred room mate name:

Triple
      preferred room mates names:

Estimated arrival Date:

Estimated departure Date:

To ensure your participation in OLFA, please submit this form online with 100$ deposit to your country VDRR by November 30, 2006