International Seminar

“Environmental Health and Sustainable Tourism”

Rotary International Convention

Toronto, Ontario, Canada
23-27 June 2019

The Keynote Speaker

 Dr. Matt Powers (AS)

 Dr. Nila Djuwita F. Moeloek (Indonesia)

 Anthony Robbins (AS)

With the famous Master of Ceremony

Billy O’Reily (AS)

Yoo Jae Suk (Korea)
Sponsor by:

Media partner:
Seminar Registration Instructions

Please read these instructions and complete the registration form to apply for a place at the
International Seminar, June 23-27, 2019.

INSTRUCTIONS
1. Complete a separate registration from each person registering.
2. Enter only one (1) address in the space below. We cannot keep records of multiple
addresses for delegates. The address you list will be the one to which we will send
correspondence and which will be listed in the Delegate Contact Sheet distributed at
the seminar.
3. Enter your name EXACTLY as you would like it to appear on your name badge and
meeting certificate (space limitations may apply).
4. Complete all fields on both pages on your computer, and then print the form.
5. Sign the credit card authorization.
6. Mail the form to email at the address on cover or fax to +1 415-353-6846.

For immediate confirmatios of your registration, complete the online seminar

registration form at ajus.org/convention. You may register online beginning November 13,
2018, at 10.00 a.m. EDT through August 12, 2018, the last day of the event.

TERMS OF PAYMENT
All payments (registration fees and social program) must be paid before you come to the
seminar. You will always receive a confirmation/ receipt of paid fees by email. If you have
not received it, please contact us. All bank charges are to be paid by the payer.
On the registration form you can choose between two payment options :
1. Credit card: VISA, ATM Card are accepted.
Please follow the instructions given on the on-line form and proceed to payment immediately
(have your card and security codes available).
2. You can ask US to send you a manually issued invoice, please choose Invoice as your
payment option on the form.

CANCELLATIONS AND REFUNDS

All cancellations and changes must be made in writing (email) to us. An unpaid registration is
not a cancellation, and cancellation fees apply even for unpaid registrations.

Cancellation received
By 30 January 2018: full refund except for the administration fee $50.
No refund will be paid for cancellations received after 30 June 2019.
There is no extra fee it your registration is transferred to a collegeague from the same
organization. Requests to cancel registrations or Rotary-ticketed events must be received in
writing by 30 April 2018. Cancellations caused by visa must be received by 27 June 2018.
For faster processing, you can sign in your account at riseminar.org to cancel your
registration or events. You may also email ri.registration@rotary.org.

REGISTRATION FORM

2018 Rotary International Seminar

Toronto, Ontario, Canada
23-27 June 2019

PLEASE COMPLETE ALL SECTIONS AND TYPE OR PRINT IN ENGLISH.

1. PERSONAL REGISTRANT DETAILS
Family Name Firts Name Middle Name/Initial

Club City District Country

Email (Required and cannot be shared by another club member or club)

Street Address or P.O. Box

City State/Province Postal Code

Business Phone (including country and city codes) Home Phone

Registration Type
 Early Bird  Mid  Late  On-site

Language Preference Accessibility Needs (check all that apply)

 English  French  Assisted-listening devices
 Italian  Japanese  Wheelchair  I will bring one
 Korean  Mandarin  Scooter  I will bring one
 Indonesia  Spanish  Braille materials
 Other
Dietary Needs (check all that apply) Additional Information
 Allergies  I wish to serve as a volunteer sergeant-at-arms. (Information will
 Vegetarian  Diabetic  No red meat be sent to you at later date.)

 No pork  No shellfish  No seafood

 Other (please specify)

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

 Rotary club  Rotary district  Direct mail  Email

 Regional magazine  riseminar.org  Social media  Other

2. MAIN PROGRAM

Day 1

Time Topik A Price Time Topik B Price