| Expression of Interest Form |
In District 9790, RYLA is an interactive, experientially-based leadership conference offered in the last week of November; 7 days and 6 nights, to support 18 - 30 year olds leading in the community and in their profession. |
| SECTION ONE
- CONTACT DETAILS |
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Please note:
Fields marked with an asterix * are compulsory.
Applications that do not address those fields will not be considered. |
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| Items marked with * MANDATORY |
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| Last Name* |
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| Given Name* |
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| Preferred Name |
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| Street Address * |
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| Suburb* |
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| Post Code* |
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| Phone (Mobile Pref)* |
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| Email Address* |
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| Preferred Contact Method Please select a value |
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| Date of Birth* |
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| Gender* |
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| How did you find out about RYLA? (please select most appropriate answer) |
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| If you chose Other, please specify |
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| SECTION TWO - ABOUT YOU |
| We need to know about you; not a resume although be really proud of everything you have done! What we want to know is what you are passionate about and what experiences you can share with others participating in RYLA. Please use under 500 words. |
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| What are you currently doing in relation to work or study?* |
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| Are you involved in volunteer or other community work? * You do not have to be involved in volunteer or community work to be considered for RYLA. |
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| Do you have the time off arranged? |
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SECTION THREE
SPECIAL NEEDS AND MEDICAL DETAILS |
Where possible, RYLA seeks to cater for individuals of all abilities, cultural and religious backgrounds, and any specific dietary or medical needs. Please use the space below to indicate any special needs you may have. This information will be retained by the RYLA Chairman and Co-directors and used only in case of emergency or to help manage a pre-existing requirement or medical condition. All information is treated with the strictest of confidence. |
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| Do you require additional support to participate in RYLA, e.g. large print handouts, wheelchair access, etc?* Please select a value. |
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| If yes, please specify details |
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| Do you have any allergies (e.g dairy allergy, nut allergy, dust, foods, perfumes) or special dietary requirements (e.g. halal, vegetarian)? Please select a value.* |
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| If yes, please specify details |
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| Do you have a medical condition that may require medication or treatment, including allergies? Please select a value.* |
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| If yes, please specify details |
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| Does this condition, or any others, require you to take regular or prescribed medication? This information will need to be provided to the Medical Officer at the commencement of the program. Please select a value. |
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| If yes, please specify details |
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| Do you have an allergic reaction to any medication(s)? E.g. penicillin, aspirin, etc. Please select a value.* |
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| If yes, please specify details |
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| Can you be administered a painkiller, e.g. aspirin or Panadol by a RYLA team member if requested? Please select a value. * |
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| Please list anything else we need to know. |
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| Name of Regular Doctor* |
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| Doctor's Phone Number* |
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| Medicare Number* |
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| Do you have Private Health Insurance? |
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| Do you have Ambulance Cover? |
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| SECTION FOUR
FINDING A SPONSOR |
If your application is successful a Rotary Club will sponsor you to attend RYLA. Every Rotary club is autonomous; each club has procedures regarding RYLA funding. A Rotarian from your sponsoring club will discuss the details with you privately. If you do not have a sponsoring club, the RYLA Supporter Team will seek a sponsoring club on your behalf. In return, you are expected to visit the sponsoring club prior to attending RYLA to introduce yourself and following RYLA to present what you experienced. Make arrangements for these visits as soon as you know what club is sponsoring you. |
| Are you currently in contact with a Rotary Club that has indicated interest in sponsoring you? |
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If NO, your application will be included in a "pool" of applicants and
we will seek to find a sponsoring club on your behalf. |
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| SECTION FIVE
RYLA RULES AND GUIDELINES |
The RYLA Supporter Team provides an interactive, experientially based conference while ensuring the comfort and safety of all participants. To facilitate a safe and comfortable experience, we ask participants to adhere to the guidelines and rules outlined below. Please read them carefully and tick the box below to indicate you have read and agree to follow the guidelines and rules. |
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1. Only prescription drugs are permitted. No alcohol or illicit drugs are to be used at or taken to the RYLA Conference.
2. Smoking is only permitted during breaks and in designated areas.
3. Bring all personal items for the full week. There is no opportunity to visit shops, pharmacies, or supermarkets.
4. Participants are not permitted to bring vehicles to RYLA.
5. Misconduct will terminate participation in RYLA and arrangements will be made to take the participant(s) home. |
| I agree to adhere to these guidelines and rules* Please select a value
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