| Club Name |
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If more than one club will collaborate, please register each club separately and list collaborators below. |
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Rotary Club of... |
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| Collaborating Clubs |
If you plan to collaborate with other clubs, please enter their names here.
Note: these clubs should also register separately.
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| Web Address |
If you would like your club listing to link to your club website,
please provide the web address for your club here. |
| http:// |
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| City |
| Please enter the name of the city nearest your club. |
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| District |
| Please enter the number of your club's Rotary District. |
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| Is your club directly on the West Coast Walk route? |
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Yes
No
Unsure
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| Will you sponsor a day's route? |
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Sponsoring the route includes donation of $1,000 (or more) to PolioPlus via West Coast Walk,
scouting the route prior to the walk, and hosting the walking team.
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Yes
No
Unsure
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| If so, do you prefer a specific day? |
Please list the walking day(s) you prefer to sponsor.
Check the route calender
to see which walking days are closest to your geographical area. (Walking day numbers are listed in the first column.)
Example: hosting on Walking Day 16 means meeting the walking team at the end of day 16 (May 18), providing dinner, lodging, and breakfast the following morning (May 19).
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| How many days can you host the walking team? |
Please select the number of days you can host the walking team.
Clubs along the route are asked to host the team for at least one day.
Hosts provide lodging and three meals for the walking team of two people.
(Separate beds, please, and one walking team member is a vegetarian.)
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None
1
2
3
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| Will you coordinate a local media event? |
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Yes
No
Unsure
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| Will you plan a related fundraiser? |
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Yes
No
Unsure
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| How much does your club plan on contributing to PolioPlus via West Coast Walk? |
Please enter the approximate amount you expect to donate.
Please use whole dollar amounts (no commas). |
| $ |
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| Are you interested in West Coast Walk merchandise? |
We have WCW T-shirts available. Cost will be $15 each online or $10 each if purchased
in one order for your club members. Proceeds will go to West Coast Walk.
If you would like to purchase shirts, please let us know how many.
If you would be interested in jackets or hats, please let us know. |
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| Contact Information |
Please provide the following information for your club's primary point of contact.
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First Name
Last Name
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Title
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Main Phone
Alt Phone
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Email
Fax
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Address
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City
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State
Zip
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Country
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| Additional Contact Information |
If you would like to register an additional contact, please provide that information here.
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First Name
Last Name
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Title
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Main Phone
Alt Phone
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Email
Fax
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Address
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City
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State
Zip
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Country
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| Comments |
Please provide any additional comments here.
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