92nd DCA Kisumu - D9212 : Registration Form

Enter your Details

* Rotary Membership :
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* Position :
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* Rotary Club Name :
* First Name :
* Last Name :
* Gender :
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Address :
City :
* Country :
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* Phone # :
* Email :
Diet Preference :
Passport/ID # :
Expiry # :
Nationality :
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Classification :
Paul Harris :
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* Badge/Call Name :

 

Would you like to register more participants :        YES         NO       How many more ? :
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