Apply for RYLA 2020

Student Name *

First Name

Last Name

Your Mobile Phone *

Please use a mobile number if you have one

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Your Birthdate *

MM

DD

YYYY

I pledge to attend and participate in all three days of RYLA. I will also return all forms on-time. *

Yes

Parent/Guardian Name *

First Name

Last Name

Parent/Guardian Phone *

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Rotarian Contact (if applicable)

First Name

Last Name