RYLA Delegate Application

Please fill out this Application Form for the RYLA Conference. It will be emailed to the conference chair when you click the 'Submit' button below.

APPLICANT INFORMATION

*Indicates a required entry

*Sponsoring Rotary Club:

*First Name:

Middle Name:

*Last Name:

*Address:

*City:

*State:

*Zip Code:

e-mail Address:

*High School:

*Date Of Birth (dd/mm/yyyy):

*Sex:

*Home Phone (xxx) xxx-xxxx:

Cell Phone (xxx) xxx-xxxx:

*Grade:

*Parents:

Future Plans:

Awards/Honors:

Clubs/Organizations:

Hobbies/Talents:

Special Diet/Special Needs:

*Shirt Size:

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SUBMISSION INSTRUCTIONS

Your application will be submitted for consideration once you click the Submit Form button below. Your application will be stored in our database for reporting purposes. You must also submit a Release Form signed by a parent or legal guardian located HERE. No applications will be considered without a signed Release Form.