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Rotary International and U.S. Department of State Conference
Ending the Tragedy of Landmines Through Innovation and Cooperation.

Registration

If you would like to register for the conference, you have two options. If you need to send a payment along with your registration, please download the conference registration form and mail it to us at MAIC, MSC 8504, Harrisonburg, VA 22807 or fax it to 1-540-568-8176.

Download the Registration Form (Adobe .pdf)

If you don't need to send us a payment, please fill out the form below.

Your name: Your email:
   
Rotary Club:  Your Address: (street, city, state) 
   
Rotary District:  Phone: Fax:
     
Rotary City:   
I will be accompanied by a spouse or guest.
 
Rotary State: 
I am an alternate Rotarian and will attend on a space-available basis.