If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required CLUB REGISTRATION APPLICATION FOR 2016 ADVENTURE IN HIGH TECHNOLOGY Hosted by the Rotary Club of Nepean-Kanata  Sponsoring Rotary Club Name * Program Coordinator’s Name * Address: Town, Province, Postal Code * Telephone: * e - Mail ... : * Signature: (Print Name and Date) * *****Enclose Application Fee of $350.00 (CDN)***** Please make checks payable to the Rotary Club of Nepean-Kanata SUNDAY, OCTOBER 16 TO THURSDAY, OCTOBER 20, 2016 SUBMIT APPLICATION BY October 5 VISIT OUR WEBSITE www.nepeankanatarotary.org AND FOLLOW THE LINK UNDER WHAT WE DO TO THE 2016 ADVENTURE IN HI-TECH