등록 신청서 및 티켓 주문서 - Rotary International
등록 신청서 및 티켓 주문서 - Rotary International
등록 신청서 및 티켓 주문서 - Rotary International
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Registration and Ticket Form<br />
2014 <strong>Rotary</strong> <strong>International</strong> Convention<br />
Sydney, Australia <br />
1-4 June 2014<br />
EN—(413)<br />
Three ways to register!<br />
1. Online at www.rotary.org (PREFERRED)<br />
2. Fax the form to RI Registration Services at +1-847-556-2194<br />
3. Mail the form to <strong>Rotary</strong> <strong>International</strong> <br />
14244 Collections Center Dr., Chicago, IL 60693 USA<br />
For your protection and compliance with Payment Card Industry<br />
(PCI) requirements, RI does not accept registration forms submitted<br />
via email. Please visit the website to register securely online.<br />
SELECTING PRECONVENTION MEETINGS AND TICKETED RI EVENTS<br />
Tickets to RI events are limited and sold on a first-come, first-served basis; advance purchase is recommended. Remember to include the<br />
preconvention meeting dates when reserving your hotel room. Preconvention meetings and ticketed RI events are open to all RI Convention<br />
registrants unless otherwise noted. Participants may attend preconvention meetings and the House of Friendship Experience without<br />
registering for the full RI Convention.<br />
Preconvention Meetings/House of Friendship<br />
Eligibility<br />
Rotaract Preconvention Meeting 30-31 May For Rotaractors and Rotarians interested in Rotaract<br />
Youth Exchange Officers Preconvention<br />
Meeting<br />
30-31 May For Rotarians working with Youth Exchange<br />
Saturday-only House of Friendship<br />
Experience<br />
Ticketed RI Events<br />
Youth Exchange Officers Banquet<br />
President’s Recognition Luncheon<br />
President-elect’s Leadership Luncheon<br />
31 May<br />
30 May<br />
2 June<br />
3 June<br />
For the family of <strong>Rotary</strong> and their guests. Provides a sample of the<br />
convention experience; available for use only on Saturday, 31 May,<br />
in the House of Friendship.<br />
Eligibility<br />
Open to all attendees at Youth Exchange Officers Preconvention Meeting<br />
and their guests<br />
Designed for current RI officers, district governors, club presidents, RI committee<br />
members, and spouses, but all convention registrants are welcome<br />
Designed for incoming RI officers, district governors, club presidents, and<br />
spouses, but all convention registrants are welcome<br />
On to São Paulo Convention Luncheon 4 June Open to all convention registrants<br />
PROCESSING AND CONFIRMATION<br />
Online registration is the preferred method of registration for immediate confirmations and letters of invitation, if needed. Hardcopy<br />
forms submitted to RI Registration Services require three to four weeks to process; please allow more time for forms submitted on or<br />
around registration deadline dates. Once your faxed or emailed registration has been processed, you will receive an email confirmation.<br />
LETTERS OF INVITATION/VISAS<br />
If Australia requires a letter of invitation of those visiting from your country of residence, RI will email you the letter in PDF format along<br />
with your emailed confirmation of convention registration. Letters are sent to the main registrant and include the names of all guests of<br />
that registrant. RI will send letters of invitation only to those who are registered for the convention. Registrants are responsible for all<br />
costs associated with attending the meeting and visa applications.<br />
If you need a visa to enter Australia, we strongly recommend ONLINE registration before the first deadline (15 December 2013) for immediate<br />
confirmations and letters of invitation. If submitting a registration form by fax or mail, please allow adequate time for registration and<br />
visa processing. Find detailed information on Australia’s visa requirements at www.immi.gov.au/visitors.<br />
Be sure to read the Cancellation Policy on the last page of this form.<br />
notices<br />
By attending the RI Convention, registrants consent to be photographed by any means, including still photography and video recording,<br />
and grant <strong>Rotary</strong> <strong>International</strong> and The <strong>Rotary</strong> Foundation the right to use and publish and license their names, voices, and likenesses<br />
forever and for any purpose worldwide without RI or the Foundation incurring debts or liabilities of any kind.<br />
For security purposes, all registrants must show photo identification (driver’s license or passport) at the convention venue in order to<br />
obtain their registration materials. RI reserves the right to check photo identification at any time during registrants’ attendance at the<br />
convention. Random spot checks will be made to compare badge information with photo identification. Badges that do not match photo<br />
identification will be confiscated without refund and violators ejected. RI reserves the right to inspect all purses and bags. Registrants<br />
may refuse inspection; RI reserves the right to prevent entry.
Registration and Ticket Form<br />
2014 <strong>Rotary</strong> <strong>International</strong> Convention<br />
Sydney, Australia <br />
1-4 June 2014<br />
Event code: IC14<br />
Please type or print clearly. Complete all 5 steps.<br />
1. Registrant Information Check all selections for the main registrant here:<br />
c Full Convention Registration<br />
c Rotarian<br />
c <strong>Rotary</strong> club/district employee<br />
c Spouse of deceased Rotarian<br />
c TRF alumnus (before 2006-07)<br />
c Rotaractor<br />
c TRF alumnus (2006-07 or later)<br />
c Youth Exchange student<br />
c Interactor<br />
c Preconvention Meetings/House of Friendship<br />
c Rotaract Preconvention Meeting<br />
c Youth Exchange Officers Preconvention Meeting<br />
c Saturday-only House of Friendship Experience<br />
c Ticketed RI Events<br />
c Youth Exchange Officers Banquet<br />
c President’s Recognition Luncheon<br />
c President-elect’s Leadership Luncheon<br />
c On to São Paulo Convention Luncheon<br />
Family Name First Name Middle Name/Initial<br />
Badge/Call Name<br />
Classification (Rotarians only)<br />
Club/City<br />
Country<br />
Membership ID (required)<br />
District<br />
c District Governor Year - c 2013-14 RI Committee/Resource Group Chair:<br />
Language Preference: Which language do you wish to use at the convention?<br />
c English c French c Italian c Japanese c Korean c Mandarin c Portuguese c Spanish<br />
Responses are used to determine the need for simultaneous interpretation, but this service cannot be guaranteed in all languages.<br />
Contact Information. Provide your current mailing address. Any changes will be reflected in your member profile.<br />
Address or P.O. Box<br />
City State/Province Postal Code Country<br />
Business Phone (including country and city codes) Home Phone Business Fax Home Fax<br />
Email (required)<br />
Parent or Guardian Information. Adult contact information is required for all registrants age 18 or younger.<br />
Family Name First Name Middle Name/Initial<br />
Phone (including country and city codes)<br />
Email<br />
Parent or guardian information will be used only for contact purposes and does not serve as convention registration for the parent or guardian.<br />
Emergency Contact during the meeting (required):<br />
Name<br />
Phone (including country and city codes)<br />
Special Needs: I require special accommodation (check all that apply): c Wheelchair (specify below if bringing your own)<br />
c Braille materials c Assisted listening devices c Other (please specify):<br />
Dietary Needs: I require special accommodation (check all that apply): c Allergies<br />
c Vegetarian c Diabetic c No red meat c No pork c No shellfish c No seafood c Other (please specify):<br />
Additional Information:<br />
c I wish to serve as a volunteer sergeant-at-arms. (Information will be sent at a later date.)<br />
c This is my first RI Convention.<br />
page 1 of 3
Event code: IC14<br />
Where did you hear about c <strong>Rotary</strong> club c <strong>Rotary</strong> district c Direct mail c 2013 RI Convention c Email<br />
the convention? (check one) c Social media c The Rotarian c Regional magazine c www.riconvention.org<br />
c 2014 Promotion Committee presentation c Other<br />
Personal Information Sharing. RI may provide your contact information to Rotarians, including zone and district promotion chairs and those organizing<br />
regional or district events, to assist them in planning convention-related activities. If you indicate that you do not want your contact information<br />
shared with others, communications about and invitations to special convention events will not be sent to you.<br />
c No, RI may not use my contact information as outlined above.<br />
2. Guest Registrant DETAILS<br />
Registration Categories<br />
1 Rotarian<br />
2 Guest age 19 or older<br />
3 <strong>Rotary</strong> club/district employee<br />
4 Spouse of deceased Rotarian<br />
5 TRF alumnus (before 2006-07)<br />
6 Rotaractor<br />
7 TRF alumnus (2006-07 or later)*<br />
8 One guest of category 6 or 7<br />
9 Youth Exchange student<br />
10 Interactor<br />
11 Guest age 5 to 18<br />
12 Guest younger than 5<br />
Check all events that apply to each individual.<br />
Guest 1 Guest 2 Guest 3<br />
c Full Convention Registration<br />
Category (see above)<br />
c Saturday-only House of Friendship<br />
Experience<br />
c Rotaract Preconvention Meeting<br />
c Youth Exchange Officers Preconvention<br />
Meeting<br />
c Youth Exchange Officers Banquet<br />
c President’s Recognition Luncheon<br />
c President-elect’s Leadership Luncheon<br />
c On to São Paulo Convention Luncheon<br />
c Full Convention Registration<br />
Category (see above)<br />
c Saturday-only House of Friendship<br />
Experience<br />
c Rotaract Preconvention Meeting<br />
c Youth Exchange Officers Preconvention<br />
Meeting<br />
c Youth Exchange Officers Banquet<br />
c President’s Recognition Luncheon<br />
c President-elect’s Leadership Luncheon<br />
c On to São Paulo Convention Luncheon<br />
Family Name Family Name Family Name<br />
First Name First Name First Name<br />
c Full Convention Registration<br />
Category (see above)<br />
c Saturday-only House of Friendship<br />
Experience<br />
c Rotaract Preconvention Meeting<br />
c Youth Exchange Officers Preconvention<br />
Meeting<br />
c Youth Exchange Officers Banquet<br />
c President’s Recognition Luncheon<br />
c President-elect’s Leadership Luncheon<br />
c On to São Paulo Convention Luncheon<br />
Middle Name or Initial Middle Name or Initial Middle Name or Initial<br />
Badge/Call Name Badge/Call Name Badge/Call Name<br />
Classification (Rotarians only) Classification (Rotarians only) Classification (Rotarians only)<br />
Club/City Club/City Club/City<br />
Country Country Country<br />
Birth Year (if under 18 only) Birth Year (if under 18 only) Birth Year (if under 18 only)<br />
Language Preference**<br />
c English c French c Italian<br />
c Japanese c Korean c Mandarin<br />
c Portuguese c Spanish<br />
Special Needs (check all that apply)<br />
c Assisted-listening devices<br />
c Wheelchair (specify below if bringing your own)<br />
c Braille materials<br />
c Other<br />
Dietary Needs (check all that apply)<br />
c Allergies<br />
c Vegetarian c Diabetic c No red meat<br />
c No pork c No shellfish c No seafood<br />
c Other<br />
c I wish to serve as a volunteer sergeant-at-arms.<br />
(Information will come later.)<br />
Language Preference**<br />
c English c French c Italian<br />
c Japanese c Korean c Mandarin<br />
c Portuguese c Spanish<br />
Special Needs (check all that apply)<br />
c Assisted-listening devices<br />
c Wheelchair (specify below if bringing your own)<br />
c Braille materials<br />
c Other<br />
Dietary Needs (check all that apply)<br />
c Allergies<br />
c Vegetarian c Diabetic c No red meat<br />
c No pork c No shellfish c No seafood<br />
c Other<br />
Language Preference**<br />
c English c French c Italian<br />
c Japanese c Korean c Mandarin<br />
c Portuguese c Spanish<br />
Special Needs (check all that apply)<br />
c Assisted-listening devices<br />
c Wheelchair (specify below if bringing your own)<br />
c Braille materials<br />
c Other<br />
Dietary Needs (check all that apply)<br />
c Allergies<br />
c Vegetarian c Diabetic c No red meat<br />
c No pork c No shellfish c No seafood<br />
c Other<br />
c I wish to serve as a volunteer sergeant-at-arms.<br />
(Information will come later.)<br />
c I wish to serve as a volunteer sergeant-at-arms.<br />
(Information will come later.)<br />
c This is my first RI Convention. c This is my first RI Convention. c This is my first RI Convention.<br />
*Rate does not apply if you were a Rotarian before your Foundation program participation (e.g., GSE team leaders and <strong>Rotary</strong> Volunteers).<br />
**Responses are used to determine the need for simultaneous interpretation, but this service cannot be guaranteed in all languages.<br />
You may need to submit up to three forms.<br />
Each form is processed by a different entity. To avoid processing delays, submit each form following the instructions:<br />
c Registration and Ticket Form (RI) c Hotel Reservation Form (Experient) c Host Event Ticket Form (HOC)<br />
page 2 of 3
3. Convention Registration Fees (All prices are in U.S. dollars and include 10% Goods and Services Tax (GST).)<br />
Event code: IC14<br />
Registration Category<br />
Register Early and Save!<br />
Deadline 1:<br />
15 December 2013<br />
Deadline 2:<br />
31 March 2014<br />
On-site/Online<br />
after 31 March<br />
1-5 US$310 US$360 US$410<br />
6-8* US$66 US$99 US$132<br />
9-11 US$11 US$11 US$11<br />
12 Free Free Free<br />
Total Registrants<br />
by Category<br />
Total<br />
(Total Registrants<br />
x Fee)<br />
*Rate does not apply if you were a Rotarian before your Foundation program participation. Registration Total: US$<br />
4. PRECONVENTION MEETINGS AND TICKETED EVENTS<br />
Participants may attend preconvention meetings and the House of Friendship Experience without registering for the full RI Convention.<br />
Quantity Price Total<br />
Preconvention Meetings/House of Friendship<br />
Rotaract Preconvention Meeting 30-31 May US$44<br />
Youth Exchange Officers Preconvention Meeting 30-31 May US$55<br />
Saturday-only House of Friendship Experience 31 May US$44<br />
Preconvention Meetings Total:<br />
US$<br />
Ticketed RI Events (total number of tickets per event must not exceed total number of convention registrants)<br />
Youth Exchange Officers Banquet 30 May US$100<br />
President’s Recognition Luncheon 2 June US$60<br />
President-elect’s Leadership Luncheon 3 June US$60<br />
On to São Paulo Convention Luncheon 4 June US$60<br />
Preconvention Meetings and Tickets Total:<br />
GRAND TOTAL:<br />
(Registration Total + Preconvention Meetings and Tickets Total)<br />
US$<br />
US$<br />
5. PAYMENT AND SIGNATURE<br />
All rates include 10% Goods and Services Tax (GST).<br />
ABN 36 434 882 113<br />
All fees must be submitted with this signed registration form and paid in U.S. dollars. RI international offices and fiscal agents will accept<br />
payment for the RI Convention, preconvention meetings, and ticketed RI events. Personal or club checks will not be accepted on-site.<br />
Please charge my (check one) c Visa c MasterCard c JCB c American Express c Diners Club c Discover<br />
Card Number:<br />
Cardholder’s Name (as it appears on card) Expiration Date (mm/yy) Security Code (3 or 4 digits) Signature (if different from below)<br />
By signing,* I submit the registration and ticket form, and I verify that I have read and agree to the notices and the cancellation policy.<br />
Main Registrant’s Signature Name (please print) Date (dd/mm/yy)<br />
All forms must be signed.<br />
*If main registrant is age 18 or younger, an adult parent or guardian must sign this form.<br />
CANCELLATION AND CHANGES<br />
All registration cancellations are subject to a US$50 service fee. Cancellation requests for registration and tickets must be received by<br />
30 April 2014. Cancellations due to an unissued visa must be received by 4 June 2014. All cancellation requests must be submitted in writing,<br />
via email to RI Registration Services (ri.registration@rotary.org) or fax (+1-847-556-2194). Phone cancellations will not be accepted.<br />
RI will refund registration and ticket fees if the 2014 RI Convention is canceled, but takes no responsibility for travel or other related costs<br />
incurred by Rotarians and their guests. Registration and tickets are nontransferable.<br />
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