Registration for: Land of Lincoln President Elect Training Seminar - LOLPETS

Please input your contact information for the event. Then click the REGISTER button to complete your registration.


Section 1 - Registrant Data:
First Name: * Middle Name:
Last Name: * Suffix:
Badge Name: (Only IF different from First Name)
Gender: * Your Rotary Club:
Email: *
City:     State:*     Zip Code:*
County:      Province:
Country: *

Please enter the security code EXACTLY as shown
on the right. The letters are lower case.

*** Optional (but Recommended) Contact Information ***
Home Phone:
(e.g., xxx-xxx-xxxx)
Business Phone:
(e.g., xxx-xxx-xxxx)
Cell Phone:
(e.g., xxx-xxx-xxxx)
Fax Number:
(e.g., xxx-xxx-xxxx)