EN(415)

REGISTRATION AND TICKET FORM

2016 Rotary International Convention
Seoul, Korea
28 May-1 June 2016

THREE WAYS TO REGISTER!

PRECONVENTION AND ROTARY-TICKETED EVENTS

1. Register online at www.riconvention.org (RECOMMENDED)

2. Fax the form to RI Registration Services at +1-847-556-2194

Please note: RI cannot

accept registration
forms submitted by
email. Allow 3-4 weeks
for processing of faxed
or mailed forms. RI will
email all confirmations.

3. Mail the form to Rotary International

Tickets are limited and sold on a first-come, first-served basis;
14244 Collections Center Dr., Chicago, IL 60693 USA
advance purchase is recommended. Preconvention and Rotaryticketed events are open to all convention registrants unless
otherwise noted. Participants may attend preconvention events without registering for the full Rotary International Convention.

Preconvention Events
Youth Exchange Officers Preconvention
Youth Exchange Officers Banquet
Rotaract Preconvention

Eligibility
27-28 May
27 May
28-29 May

Rotary-Ticketed Events

For Rotarians who work with Youth Exchange

Open to all Youth Exchange Officers Preconvention participants and their
guests, but all convention registrants are welcome
For Rotaractors and Rotarians interested in Rotaract

Eligibility

Presidents Recognition Luncheon

30 May

Designed for current RI officers, district governors, club presidents, RI committee members, and spouses, but all convention registrants are welcome

President-elects Leadership Luncheon

31 May

Designed for incoming RI officers, district governors, club presidents, and

their spouses, but all convention registrants are welcome

On to Atlanta Convention Luncheon

1 June

Open to all convention registrants

CANCELLATION AND CHANGES

All registration cancellations are subject to a $50 service fee. Requests to cancel registrations or tickets must be received by 30 April
2016. Cancellations caused by visa denial must be received by 1 June 2016. You can sign in to your account at www.riconvention.org
to cancel your registration or submit the request to RI Registration Services by emailing ri.registration@rotary.org or sending a fax to
+1-847-556-2194. Cancellations cannot be accepted by phone.
RI will refund registration and ticket fees if the 2016 Rotary International Convention is canceled but shall not be responsible for travel
or other related costs and expenses incurred by Rotarians and their guests. Registration and tickets are not transferable.

LETTERS OF INVITATION AND VISAS

Visa requirements vary by country of citizenship. If a letter of invitation is required, RI will email you the letter as a PDF along with
your registration confirmation. Letters will be sent to the main registrant and include all guests names. RI will send letters of invitation
only to those who are registered for the convention. Registrants are responsible for all costs associated with attending preconvention
events, Rotary-ticketed events, and the convention and applying for visas.
If you need a visa to enter Korea, we strongly recommend registering ONLINE by 15 December 2015 so you can receive immediate
confirmation of your registration and letter of invitation. If you submit a registration form by fax or mail, please allow adequate time
for registration and visa processing. Find information on Koreas visa requirements at:
www.hikorea.go.kr/pt/InfoDetailR_en.pt?categoryId=2&parentId=385&catSeq=401&showMenuId=375.

PROCESSING AND CONFIRMATION

Online registration is the fastest and most secure method of registration and provides immediate receipt of confirmations and letters
of invitation, if needed. Hard-copy forms submitted to RI Registration Services require three to four weeks to process; please allow
more time for forms submitted on or around registration deadline dates. Once your faxed or mailed registration has been processed,
you will receive an email confirmation. A unique email address is required for each registration.

NOTICES
By attending the Rotary International Convention, preconvention events, and Rotary-ticketed events, registrants consent to be photographed by any means, including still photography and video recording, and grant Rotary International and The Rotary Foundation
the right to use and publish and license their names, voices, and likenesses forever and for any purpose worldwide without RI or the
Foundation incurring debts or liabilities of any kind.
For security purposes, all registrants must show photo identification (drivers license or passport) at the convention venue in order to
obtain their registration materials. RI reserves the right to check photo identification at any time during the convention. Spot checks will
be made to compare badge information with photo identification. Badges that do not match photo identification will be confiscated
without refund and violators will be ejected from the convention. RI reserves the right to inspect all purses and bags. Registrants may
refuse inspection; however, RI reserves the right to prevent entry.

Event code: IC16

REGISTRATION AND TICKET FORM

2016 Rotary International Convention
Seoul, Korea
28 May-1 June 2016

PLEASE COMPLETE ALL FIVE SECTIONS.

1. MAIN REGISTRANT DETAILS

Membership ID (required for Rotarians)
Family Name

First Name

Badge/Call Name

Classification (Rotarians only)

Club/City

Country

Middle Name/Initial

District

Contact Information Provide your current mailing address. Any changes will be reflected in your member profile.
Address or P.O. Box

City

State/Province

Postal Code

Country

Business Phone (including country and city codes)

Home Phone

Business Fax

Home Fax

Email (Required and must be unique. Email address cannot be shared by another club member or club.)

Parent or Guardian Information Contact information for an adult is required for all registrants age 18 or younger.
Parent or guardian information will be used only for contact purposes and does not register the parent or guardian for the convention or any events.
Family Name

First Name

Phone (including country and city codes)

Email

Emergency Contact during the meeting (required):

Name

Language Preference
c English c French c Italian c Japanese
c Koreanc Mandarinc Portuguesec Spanish
Responses are used to determine the need for simultaneous
interpretation, but this service cannot be guaranteed in all languages.
Dietary Needs I require special accommodation (check all that apply):
c Allergies
c Vegetarian c Diabetic c No red meat c No pork
c No shellfish c No seafood c Other (please specify):

Middle Name/Initial

Phone (including country and city codes)

Special Needs I require special accommodation (check all that apply):
c Wheelchair/Scooter (specify below if bringing your own)
c Braille materials
c Assisted-listening devices
c Other (please specify):
Additional Information
c I wish to serve as a volunteer sergeant-at-arms.
(Information will be sent at a later date.)
c This is my first Rotary Convention.
I prefer to receive the convention program by:
c Printed program book c Mobile application

Registration Selection
Convention Registration Category (select one): 
c 1 Rotarian c 3 Rotary club/district employeec 4
 Spouse of deceased Rotarian c 5 Non-Rotarian alumnus
c 6 Rotaractor c 8 Youth Exchange student c 9 Interactor
Preconvention Events
c Youth Exchange Officers Preconvention
c Youth Exchange Officers Banquet
c Rotaract Preconvention

Rotary-Ticketed Events
c Presidents Recognition Luncheon
c President-elects Leadership Luncheon
c On to Atlanta Convention Luncheon

Where did you hear about the convention? (check one)

c Rotary club c Rotary district c 2015 RI Convention c Email c Social media c The Rotarian c Regional magazine
c www.riconvention.org c 2016 Promotion Committee presentation c Other
Personal Information Sharing Your privacy is important to Rotary. Your personal information may be shared with Rotarys affiliated entities and service
providers to assist them in planning convention-related activities. Your personal information will only be used for official Rotary business. Please check the
box below if you do not want your personal information shared for convention-related activities.

c I do not want my personal information shared for convention-related activities.

Page 1 of 3

Event code: IC16

2. GUEST REGISTRANT DETAILS

If more than three guests will accompany you, attach additional copies of this page as needed. Complete only the guest section on the additional forms.

Registration Categories
1 Rotarian
2 Guest age 19 or older
3 Rotary club/district employee

4 Spouse of deceased Rotarian

5 Non-Rotarian alumnus
6 Rotaractor

7 Guest of category 5 or 6
8 Youth Exchange student
9 Interactor

10 Guest age 5 to 18
11 Guest younger than 5

Guest 1 Category # (see above)

Guest 2 Category # (see above)

Guest 3 Category # (see above)

Family Name

Family Name

Family Name

First Name

First Name

First Name

Middle Name or Initial

Middle Name or Initial

Middle Name or Initial

Badge/Call Name

Badge/Call Name

Badge/Call Name

Classification (Rotarians only)

Classification (Rotarians only)

Classification (Rotarians only)

Club/City

Club/City

Club/City

Country

Country

Country

Birth Year (if under 18 only)

Birth Year (if under 18 only)

Birth Year (if under 18 only)

Language Preference*
c English c French c Italian c Japanese
c Korean c Mandarin c Portuguese
c Spanish

Language Preference*
c English c French c Italian c Japanese
c Korean c Mandarin c Portuguese
c Spanish

Language Preference*
c English c French c Italian c Japanese
c Korean c Mandarin c Portuguese
c Spanish

Special Needs (check all that apply)

c Assisted-listening devices
c Wheelchair/Scooter (specify below if bringing
your own)
c Braille materials
c Other

Special Needs (check all that apply)

c Assisted-listening devices
cW
 heelchair/Scooter (specify below if bringing
your own)
c Braille materials
c Other

Special Needs (check all that apply)

c Assisted-listening devices
cW
 heelchair/Scooter (specify below if bringing
your own)
c Braille materials
c Other

Dietary Needs (check all that apply)

c Allergies
c Vegetarian c Diabetic c No red meat
c No pork c No shellfish c No seafood
c Other

Dietary Needs (check all that apply)

c Allergies
c Vegetarian c Diabetic c No red meat
c No pork c No shellfish c No seafood
c Other

Dietary Needs (check all that apply)

c Allergies
c Vegetarian c Diabetic c No red meat
c No pork c No shellfish c No seafood
c Other

Preconvention and Rotary-Ticketed Events

c Y
 outh Exchange Officers Preconvention
c Youth Exchange Officers Banquet
c Rotaract Preconvention
c Presidents Recognition Luncheon
c President-elects Leadership Luncheon
c On to Atlanta Convention Luncheon

Preconvention and Rotary-Ticketed Events

c Y
 outh Exchange Officers Preconvention
c Youth Exchange Officers Banquet
c Rotaract Preconvention
c Presidents Recognition Luncheon
c President-elects Leadership Luncheon
c On to Atlanta Convention Luncheon

Preconvention and Rotary-Ticketed Events

c Y
 outh Exchange Officers Preconvention
c Youth Exchange Officers Banquet
c Rotaract Preconvention
c Presidents Recognition Luncheon
c President-elects Leadership Luncheon
c On to Atlanta Convention Luncheon

Additional Information
c I wish to serve as a volunteer sergeant-at-arms.

Additional Information
c I wish to serve as a volunteer sergeant-at-arms.

Additional Information
c I wish to serve as a volunteer sergeant-at-arms.

(Information will come later.)

(Information will come later.)

(Information will come later.)

c This is my first Rotary convention.

c This is my first Rotary convention.

c This is my first Rotary convention.

I prefer to receive the convention program by:

c Printed program book c Mobile application

I prefer to receive the convention program by:

c Printed program book c Mobile application

I prefer to receive the convention program by:

c Printed program book c Mobile application

*Responses are used to determine the need for simultaneous interpretation, but this service cannot be guaranteed in all languages.

Page 2 of 3

Event code: IC16

3. CONVENTION REGISTRATION FEES (All prices are in U.S. dollars and inclusive of tax)
Register Early and Save!
Registration Category

Deadline 1:
15 December 2015

Deadline 2:
31 March 2016

After 31 March
(On-site or Online)

1-4

$310

$375

$440

5-7

$70

$100

$130

8-10

$10

$10

$10

11

Free

Free

Free

Total Registrants
by Category

Total
(Total Registrants
x Fee)

Registration Total: $

4. PRECONVENTION AND ROTARY-TICKETED EVENTS

Preconvention Events

Quantity

Youth Exchange Officers Preconvention

Youth Exchange Officers Banquet
Rotaract Preconvention

Price

27-28 May

$60

27 May

$100

28-29 May

$60

Preconvention Events Total:

Total

Rotary-Ticketed Events (total number of tickets per event must not exceed total number of convention registrants)
Presidents Recognition Luncheon

30 May

$55

President-elects Leadership Luncheon

31 May

$55

1 June

$55

On to Atlanta Convention Luncheon

Rotary-Ticketed Events Total:

GRAND TOTAL:
(Registration Total + Preconvention Events Total + Tickets Total)

All rates inclusive of tax.

5. PAYMENT AND SIGNATURE
All fees must be submitted with this signed registration form. All personal check payments must be drawn on a U.S. bank in U.S. dollars. RI international offices and fiscal agents will accept payment for the convention and events. Personal or club checks cannot be accepted on-site.
Credit Card Typec Visac MasterCardc JCBc American Express
Expiration Date (mm/yy)

Card Number

Cardholders Name (as it appears on card)

Signature (if different from below)

Security Code (3 or 4 digits)

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.
Main Registrants Signature

Name (please print)

Date (dd/mm/yy)

*If main registrant is age 18 or younger, an adult parent or guardian must sign this form.

CANCELLATION AND CHANGES

All registration cancellations are subject to a $50 service fee. Requests to cancel registrations or tickets must be received by 30 April 2016. Cancellations
caused by visa denial must be received by 1 June 2016. You can sign in to your account at www.riconvention.org to cancel your registration or submit the
request to RI Registration Services by emailing ri.registration@rotary.org or sending a fax to +1-847-556-2194. Cancellations cannot be accepted by phone.
RI will refund registration and ticket fees if the 2016 Rotary International Convention is canceled but takes no responsibility for travel or other related costs
incurred by Rotarians and their guests. Registration and tickets are not transferable.

THREE WAYS TO REGISTER!

1. Register online at www.riconvention.org (RECOMMENDED)
2. Fax the form to RI Registration Services at +1-847-556-2194
3. M
 ail the form to Rotary International
14244 Collections Center Dr., Chicago, IL 60693 USA

Please note: RI cannot

accept registration
forms submitted by
email. Allow 3-4 weeks
for processing of faxed
or mailed forms. RI will
email all confirmations.
Page 3 of 3