home page Contact Us

Home
President's Message
Meeting Information
 
Calendar
Rotary in the News

Events - Coming Soon

RYLA
RYLA FORMS
 

Past Events

Breakfast w Santa Dec 11
Flatbread Fundraiser
Bedford Day
9/11 Memorial Service
Golf Tournament
 

Service Projects

Service Above Self
 
Bedford Rotary Foundation
 
Interact
 

About Our Club

Officers & Directors
Club Members
Photo Album
Newsletter
 

About Rotary

What Is Rotary?
Rotary Foundation
Four Way Test
Five Avenues of Service
 
Becoming A Member
 
Bedford Rotary Blog
 
Useful Links
Meeting Makeups
 
Contact Us
Site Map

For members...




Administration Login
 
RYLA Rotary Youth Leadership Conference - RYLA Forms
click to print this pageprint this page

Rotary District 7910 Youth Leadership Conference
RYLA CONFERENCE STUDENT APPLICATION FORM

Dates: June 22-24, 2012
Place:  Worcester State College, Worcester, MA

  • The entire cost of attending the RYLA Conference will be paid by your local Rotary Club.
  • Successful applicants are required to attend the entire conference and must stay on campus until the end of the program on Sunday. Exceptions will not be made.
  • Successful applicants will be required to provide a medical history and liability waivers.
  • Application Deadline:  January 6, 2012   
  • Mail hardcopy application to:

Rotary Club of Bedford

 Att: Victor Tom

 P.O. Box  414

Bedford, MA 01730  

Email questions to vtom0@yahoo.com.

Please type or print your responses neatly.

Name:

Age: 

Gender: q M  q F   

Street Address:

City: 

Zip:  

Phone #:

Email Address:

High School:

Grade: 

School Reference:                                                                Phone:

Personal Reference:                                                             Phone:

Interests, special talents, hobbies (music, sports, acting, writing, debating, etc.):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Awards (civic and school): 

 

 

 

 

 

 

 

Extra-curricular Activities (school and community): 

 

 

 

 

 

 

 

 

 

 

 

Leadership Positions (in and out of school): 

 

 

 

 

 

 

 

Service to Community (in and out of school):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Rotary International's motto is SERVICE ABOVE SELF.

What profession(s) are you considering after high school? 

 

 

 

 

Signed:

Date:

FOR CLUB USE ONLY

Interview Date:  ___ / ___ / ___  Time: ______________ AM / PM               q PAR                                              qALT

Club Interviewer(s) _________________________ Rotary Club of ________________