ROTARY - a global network of business and professional leaders who volunteer their time and talents to serve their communities and the world.                             ROTARY - a global network of business and professional leaders who volunteer their time and talents to serve their communities and the world.                            ROTARY - a global network of business and professional leaders who volunteer their time and talents to serve their communities and the world.
                           
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RYPEN Index Information Application Form Venue & Location      
ROTARY YOUTH PROGRAM FOR ENRICHMENT
RYPEN Nomination Form
This nomination is confidential to the District 9790 RYPEN Committee
Click here for full information
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Sponsor Details
Your Name:
Your email:
Your Contact Phone Number:
Your Fax number: 
Sponsor club - Rotary Club of: 

  

Student Information
Student Name:
Gender: Male   Female
Student Email Address:
Student Date of Birth:
 Street Address:
Student Suburb:
Student Post Code:
Student Tel AH:
Student Tel BH:
Student Fax:
Year Level at School:

School Information
School Attended:
School Address:
School Suburb:
School Post Code:
School Telephone:
Other Information
Main Interests at School:

There is plenty of space for 
lengthy comments if needed.

:
Main Interests outside School:

There is plenty of space for 
lengthy comments if needed.
Jobs or Positions Held:

There is plenty of space for 
lengthy comments if needed.
Date:    Please select the date
Month and Year:    Please select the month
   

If this nomination is successful you will be required to furnish:

  1. A letter of support from the school principal whichmust be sent separately
  2. You will be required to complete and sign a medical report
  3. and complete and sign a consent form
   
 
 

 

 
 
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Special thanks to Tord Elfwendahl of the Stockholm Strand Rotaryklub (Sweden) for
his incredible Rotary graphic images which we have used throughout this web site.

Material on this site is Copyright
Rotary International; Rotary International District 9790 Inc; Tony Ladgrove, Phil MacDonald and Robin Chapple
and may not be reproduced without permission

 
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Last modified: 26 Jan 2012 08:40