2009 INTERACT DISTRICT 5000 CONVENTION by jianglifang

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									          2011 INTERACT DISTRICT 5000 CONVENTION
                  Youth The Future Of Rotary
                     February 25, 26, & 27, 2011
                         Ala Moana Hotel
                           Oahu, Hawaii

                 REGISTRATION PACKAGE

                      Convention Overview

                        Friday – February 25

        5:00 PM - Bus Transportation From Airport to Reception
   6:00-7:30PM - Evening: Reception/Mixer, Sacred Hearts Academy
          7:30PM - Transportation to Hotel from Sacred Hearts
      8:00-9:00PM - Hotel Registration (Pick up breakfast in a Bag)
                9:00-10:00PM - Chaperoned Free Time
                      10:00PM – LIGHTS OUT

                       Saturday – February 26

               6:30-7:15AM - Check in and Registration
                7:30 AM - Roll Call (registration desk)
                           Breakfast in a Bag
               8:00 Bus Transportation to USS Missouri
              8:30-11:15 Service Project – USS Missouri
               11:30 – Bus Transportation to Ice Palace
         11:45-1:00 – Ice Palace – Pizza Lunch and Ice Skating
                1:00 PM – Bus Transportation to Hotel
                       1:30-3:00 PM – Free Time
              3:00-5:00 PM - Interact Program (Rumors)
                     5:45-8:00 PM – Dinner Dance
                  8:00-10:00 – Chaperoned Free Time
                         10:00 – LIGHTS OUT

                         Sunday – February 27

             8:00-9:00 AM Buffet Breakfast, Garden Lanai
                     9:00-10:00 Interact Program
10:00-12:00 AM – Polio Awareness Project – Ala Moana Shopping Center
                             12:00 PAU
                  3:00 Bus Transportation to Airport
                                    2011 INTERACT DISTRICT 5000 CONVENTION
                                              Youth The Future Of Rotary
                                                  February 25, 26, & 27, 2011
                                                      Ala Moana Hotel
                                                        Oahu, Hawaii


                             Registration Instructions for Students, Faculty and Rotarians
Welcome to the 2011 Interact Convention
District 5000 Rotary is pleased to welcome you to the District 5000 2011 Interact Convention. The work of Interact Clubs has made
a great difference both here in Hawaii and around the world. We are very happy you have chosen to attend the convention and hope
that the convention provides an opportunity for you to meet other club members from across the state to establish new friendships and
associations for your club. Please take a moment to read the following instructions on completing the registration information for the
convention.
Incomplete information may result in a delay or inability to register you for the convention.
All completed registration packets and payments must be received by JANUARY 21, 2011. The registration information that
should be returned with your check payment for the convention is the Registration Form, Medical Information &
Parent/Guardian Consent form, and Interact Convention Rules and Regulations. Please keep a copy for your records.

Students, Faculty and Rotarians must complete the name, address, phone and email contact information, Interact club name and
registrant information (Interactor, Faculty Advisor or Rotarian). In order to facilitate the assignment of rooms, students should
complete the gender designation in addition to the other information.

Rates are provided for quadruple occupancy for Friday and Saturday nights and include convention registration fee, meals, scheduled
ground transportation, porterage, and other convention costs

A check for this amount should be made payable to the “2011 Interact Convention” and mailed to the address shown on the
Registration Form.

Please be advised that each Interact Club attending must be accompanied by a Faculty or Rotarian advisor.

If you will need scheduled transportation from airport to the resort, you will need to complete the airline information
on the registration. You will be contacted with the transportation schedule.

Mail completed forms with payment to:

Interact Convention 2011
C/O Akamai Painting
PO Box 30527
Honolulu, HI 96820


FAX: 808 834-1904

Or email:

Donna McLaughlin, mclaughlj003@hawaii.rr.com
                                     2011 INTERACT DISTRICT 5000 CONVENTION
                                           Youth ~ The Future Of Rotary
                                                 February 25, 26, & 27, 2011
                                                     Ala Moana Hotel
                                                       Oahu, Hawaii

                                            REGISTRATION FORM
                                           DEADLINE: January 21, 2011
Printed Name: ________________________________ Sponsor Rotary Club: ___________________________
Address: _________________________________________ City: __________________ ZIP: _____________
Home Phone: __________ Other Phone: __________ Email: ________________________________________
Interact Club Name: __________________________ School: ___________________________Grade_______
Adult Chaperone: ____________________________ Phone: _____________ Email:_____________________

Check all that apply

____ Interactor ____ Faculty Advisor ____ Rotarian ____ Youth Exchange ___ Rotaractor

___ Male ___ Female (Information will be needed for student room assignments)

Vegetarian? ___ YES ____ NO

COST (Registration Fee, Lodging, Meals, Meeting supplies, Scheduled transportation)
Please check one:

STUDENTS/ADULTS                             FRIDAY/SATURDAY                               SATURDAY (ONLY)

Per attendee (based on quad occupancy                $195.00 ____                                $175.00 ____

Per attendee (based on triple occupancy              $217.00 ____                                187.00    ____
Roomate requests must be specified

Per attendee (based on double occupancy              $263.00 ____                                $210.00 ____

____Please check if you will attend Friday Night Mixer - No Charge -Convention registration fee not required

ADULTS ONLY                                     FRIDAY/SATURDAY                             SATURDAY (ONLY)

Per adult (based on single occupancy                 $393.00 ____                                $275.00 ____


Make Checks Payable To: 2011 Interact Convention

Mail Payments and Registration to:
2011 Interact Convention
   c/o Akamai Painting
   PO Box 30527
   Honolulu, HI 96820

Emailed information must be sent directly to Donna Mc Laughlin at mclaughlj003@hawaii.rr.com.
Late applications will be date stamped, and processed ONLY after payment has been received.

     ROOMING REQUESTS ARE NOT GUARRANTEED… BEST EFFORT WILL BE MADE
Roommate request: Please check one of the options listed below

___ As required for triple or double occupancy

___ I would like to room with specific students with the understanding rooming requests are not guaranteed

Roommate requests - please print their name(s) in the space provided below.

1) ________________________________________            2) ______________________________________

3) ________________________________________

Airline information: Neighbor Island Attendees:
Arrival: Date: _________ Time: ________ Airline: ___________________ Flight: _______
Return: Date: _________ Time: ________ Airline: ___________________ Flight: _______
                               2011 INTERACT DISTRICT 5000 CONVENTION
                                        Youth The Future Of Rotary
                                            February 25, 26, & 27, 2011
                                                Ala Moana Hotel
                                                  Oahu, Hawaii



        MEDICAL INFORMATION & PARENT/GUARDIAN CONSENT

                                       MEDICAL INFORMATION
Please list any illnesses or health condition we should be aware of, including medication currently taken:

_____________________________________________________________________________________________
_______________________________________________________________________________________

District 5000 Interact, District 5000 Rotary or Rotary International will not be responsible for dispensing
medication. In the event of a medical emergency, qualified emergency medical personnel will be used to treat the
individual involved.

                                  PARENT AND/OR GUARDIAN CONSENT

Parent’/Guardian’s Name: ____________________________________________________________________
Contact Phone Number(s): ____________________________________________________________________
In case of emergency, please contact (if other than parent/guardian)
Name: _________________________ Relationship: __________________ Telephone: ___________________

______________________________________, has my permission to participate in the 2011 District 5000 Interact
Convention to be held on the island of Oahu at the Ala Moana Hotel, February 25, 26, 27, 2011. I understand that
all school rules, Hotel rules, and Interact Convention rules and regulations will apply throughout the convention and
should my son/daughter or ward violate any of the rules or regulations, he/she will be sent home immediately at my
expense and that the fees paid for the convention will not be refunded.

Furthermore, I, the undersigned, hereby release Interact Distinct 5000, Rotary International, its members and faculty
advisors from any and all liabilities resulting directly or indirectly from injuries to my son/daughter or ward named
above while participating in convention activities or while traveling to and from the convention.

Interact Member’s Printed Name: ______________________________________________________________
Interact Member’s Signature: _______________________________________ Date: ___________________
Parent’s/Guardian’s Printed Name: _____________________________________________________________
Parent’s/ Guardian’s Signature: ______________________________________ Date: ___________________
                                     2011 INTERACT DISTRICT 5000 CONVENTION
                                               Youth The Future Of Rotary
                                                    February 25, 26, & 27, 2011
                                                        Ala Moana Hotel
                                                          Oahu, Hawaii

                                                  RULES AND REGULATIONS


DEPARTMENT OF EDUCATION:
The Department of Education (DOE) and each respective school have rules and regulations that must be followed for off-campus
student activities. The following rules and regulations are issued pursuant to the requirements of Rotary District 5000 and the
guidelines furnished by Rotary International and are not meant to contradict any DOE or school directive. Should a conflict arise
between these rules and regulations and any DOE or school directive, the DOE or school directive will prevail. Although private
schools may operate under different rules and regulations than the DOE, in order to be consistent and fair to all students, the DOE
rules and regulations and Interact Convention Rules and Regulations will be apply to all students attending the convention.
All convention participants must observe the following rules and regulations throughout the entire convention. Failure to do so will
result in immediate dismissal from the convention. No refunds will be made for convention proceedings missed due to a dismissal.
Any and all additional costs incurred as a result of a dismissal such as, but not limited to, ground transportation, airline transportation,
long distance telephone calls, etc., will be charged to the dismissed party.

DOE and applicable school rules will be enforced during the convention by Faculty Advisors, Rotary Advisors or Rotarians acting in
place of Faculty Advisors.

All hotel rules and regulations will be observed at all times. Any damage to the hotel caused by a participant will be charged to the
individual causing the damage.

Use of the swimming pool or beach for swimming or other water activities is prohibited during the convention due to the DOE
requirement that a qualified life guard be hired for each group of six students.

 Drinking or possession of alcoholic beverages, smoking or gambling will not be tolerated. This rule and the related disciplinary
action will apply to anyone in the immediate vicinity of someone in violation of this rule.

Students are not allowed to leave the convention or hotel without the express permission of their Faculty Advisor.

Persons not registered with the convention are not allowed in hotel rooms occupied by Interact Club Members.

 Hotel guests or other persons not registered with the convention who attempt to become involved in the convention activities or with
convention attendees without prior approval of the District 5000 Interact Committee, must be reported immediately to the Faculty
Advisor, Rotary Advisor or Rotarians present at the convention. This information will be given to the District 5000 Interact
Committee for action.

Hotel rooms will only be occupied by Interact Club Members of the same gender.

 All participants must attend all convention activities unless specially excused by their Faculty Advisor, Rotary Advisor or Rotarians
acting in place of the Faculty Advisor.

 The dance on Saturday night will end by 8:00 PM. Interact Club Members will return to their rooms immediately after the dance
unless otherwise directed by the Faculty Advisor, Rotary Advisor or Rotarians acting in place of Faculty Advisor.

Unannounced spot-checks on rooms will be done at the will and discretion of the responsible same gender Faculty Advisor, Rotary
Advisors or Rotarians acting in place of Faculty Advisor.

Students are required to follow the direction of the Faculty Advisor, Rotary Advisor or Rotarian acting in place of the Faculty
Advisor except where this would substantially jeopardize the safety and/or welfare of the student.
We, the undersigned, have read and understand completely the above rules and will comply with them in their totality.

Convention attendee’s printed name:
______________________________________________________________________________
Attendee’s signature: ___________________________________________________________ Date: _______________________

Parent/Guardian’s printed name: _________________________________________________________________________________
Parent/Guardian’s signature: _____________________________________________________ Date: _______________________
                                    USS Missouri Memorial Association Inc.

                         APPLICATION FOR VOLUNTEER (Please print clearly)

Organization:                                        Today’s Date:
Name of Volunteer:                                          Age if under 18:
Parent/Guardian Name (if volunteer under 18):
Address:                                                       City:
State:                           Zip Code:                 Phone:
E-mail:
Physical/ Medical Limitations:
Any Special Skills (electrical, computer, foreign Language, etc):
Emergency Contact:                                        Phone:

                             LIABILITY & INDEMNIFICATION AGREEMENT

I acknowledge that activities aboard the USS Missouri Memorial Battleship
contain many hazards. The many possibilities and sources of death or physical
injury or property damage are acknowledged by me, and I have become a volunteer of
the Association with the knowledge of such hazards and risks. As part of the
consideration for being allowed to become a volunteer for the Association, I, for
myself, my heirs, assigns, agents, and those acting on my behalf, fully and
forever unconditionally and without possibility of revocation release, acquit,
discharge an covenant not to sue or otherwise institute legal or administrative
proceedings against the Association, its subsidiaries, successors, assigns,
directors, officers, employees, agents, attorneys, consultants, insurers, and/or
anyone acting on its behalf, and/or any individual or entity whatsoever, from
all liability for personal injury (including wrongful death) or property damage
suffered by me which is caused, in whole or in part, by any activity or condition on
board the USS Missouri, the FOXTROT 5 Pier, or anywhere else the Association
operates, even if the injury or damage is caused, in whole or in part, by the
negligence of the Association or its employers.
THE VOLUNTEER HAS READ THIS RELEASE OF LIABILITY AND INDENIFICATION
AGREEMENT AND UNDERSTANDS IT. HE/SHE IS SIGNING IT FREELY AND VOLUNTARILY.
ACCEPTED AND AGREED TO THIS                            ______
                                  Day        month      year


___________________________
Signature


___________________________
Guardian Signature if under 18

								
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