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VIBRANT CLUB SEMINAR 2020 REGISTRATION FORM
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First Name
*
Your answer
Surname
*
Your answer
Email address
*
Your answer
Contact phone number
*
Your answer
Club
*
Please select your Club's name from the list.
Choose
Alexandra
Aparima
Balclutha
Cromwell
Dunedin
Dunedin Central
Dunedin East
Dunedin North
Dunedin South
Fiordland
Gore
Invercargill
Invercargill East
Invercargill North
Invercargill South
Invercargill Sunrise
Milton
Mosgiel
Mount Aspiring
Oamaru
Queenstown
St Kilda Sunrise
Taieri
Temuka-Geraldine
Timaru
Timaru North
Waimate
Wanaka
WASH e-Club
Winton
OTHER Club
If OTHER club please enter the club name
Your answer
Position for 2020-21
*
President (2020-2021)
President Elect (for 2021-22)
Secretary
Treasurer
Director / Board member
Committee Chair
Presenter / Trainer / Seminar admin
Other:
Special dietary requirements
*
None
Gluten free
Diabetic
Vegetarian
Other:
Questions / Comments?
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