Expression of interest

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This Expression of Interest for the Rotary Youth Leadership Award should only take you about 10 minutes to complete. We collect this information to help us connect you to a Rotary Club so that they can formally consider your interest and provide sponsorship.

Have the following information available to complete the EOI:

Your personal information including contact details and date of birth
What you are currently doing for work and if you are contributing to your community – describe what you do
If you have been in contact with a Rotary Club and their contact details if you have
Your t-shirt size (in cm)
Pay a non-refundable $80 contribution to attend RYLA

The information is collected to assist with the RYLA application process and management of the conference. Further details about how we use your personal information is provided at the end of this form and on our website.

For more information about how Rotary International District 9790 Inc. (ABN 48335105362) uses your personal information, processes payments and manages refunds, see our policies page.

First name*

Surname*

Preferred name

Date of birth*

Day

Month

Year

Pronouns*

She/Her

He/Him

They/Them

Prefer not to answer

Other

Gender*

Woman or female

Man or male

Non-binary

Prefer not to answer

Other

Do you identify as cis or trans?*

Cis includes persons whose gender is the same as their sex recorded at birth.

Cis

Trans

Prefer not to answer

For more information about pronouns and why we are asking, see: Minus18

Are you of Aboriginal and/or Torres Strait Islander origin?

For persons of both Aboriginal and Torres Strait Islander origin, mark both responses: Yes Aboriginal, and Yes Torres Strait Islander.

Yes, Aboriginal

Yes, Torres Strait Islander

Email*

This email will be used for confirmation and communication.

Mobile Phone*

We may contact you by phone or text to confirm your availability and send updates about the conference.

How did you find out about RYLA?

If it’s a person we’d like to know who they are.

Have you attended RYLA before?*

Let us know if you have attended the Rotary Youth Leadership Award before in any location around the world. This includes other in Rotary districts, multi-district and international RYLA events.

Yes

I understand that as I have attended RYLA before I am liable for the full conference fee.*

Rotary sponsorship is not available to RYLArians attending the conference multiple times.

I agree to pay the full conference fee.

About you

Please be as detailed as possible in this section as your responses will be sent to a Rotary Club to assist them when considering your application. If your answers are not detailed enough we may come back to you to ask for more.

Describe what are you currently doing for work or study.*

Describe what volunteer or other community work you are involved in.*

You do not have to be involved in volunteer or community work to be considered for RYLA.

Do you have the time off arranged?*

The RYLA conference is happening from 24 to 30 November 2024. At the discretion of the RYLA committee, you may be liable for a $500 cancellation fee if you indicate you have time off and remove yourself from the conference within a month of the start date.

Yes

Are you currently in contact with a Rotary Club that has indicated interest in sponsoring you?*

If NO, your application will be included in a “pool” of applicants and we will seek to find a sponsoring club on your behalf.

Yes

What suburb or town do you live in?*

We use this information to help connect you with a sponsor club.

What suburb or town do you work in?*

Sponsor Club

Your form will be automatically sent to the sponsor club so please ensure that you enter these details carefully, especially the email address. If you don’t have this information please save the form, confirm the info and come back. Your sponsorship cannot be processed without this information!

Name of Sponsor Club:*

Just enter the club’s name, not the “Rotary Club of” bit. For example, “Rotary Club of Anytown” is just “Anytown”.

Name of your contact in the club:*

Contact's Email:*

Shirt size

We sometimes provide a shirt to our RYLA participants. Please select the size you need from one in the table below. If your size is not listed, please contact us.

Feminine shirt cuts:

	8	10	12	14	16	18	20
Chest	43.5	46	48.5	51	53.5	56	58.5
Length	62.5	64.5	66.5	68.5	70.5	72.5	73.5

“All gender” shirt cuts:

	2XS	XS	S	M	L	XL	2XL	3XL	4XL	5XL	6/7XL	8/9XL
Chest	48.5	51	53.5	56	58.5	61	63.5	66	68.5	71	76	81
Length	64.5	67.5	70.5	73	75.5	78	80.5	81.5	82.5	83.5	85.5	86.5

Shirt cut*

Select your preferred shirt cut

Feminine

All gender

Feminine shirt size

'All gender' shirt size

Consent

Please read and agree to the following rules and conditions. Please note that many of the rules and conditions are for health and safety reasons.

RYLA EOI and conference terms*

I agree to:
• Participate fully in the Rotary Youth Leadership Award (RYLA) conference
• Abide by the guidelines set by the RYLA conference Supporters and the Doxa Youth Foundation
• Not take or consume alcohol and/or illicit drugs during the conference
• Not bring my private vehicle to the conference – RYLA starts on the bus and I will board the bus at my nominated stop
• Not leave the RYLA location without notice to/authority from the conference committee
• Present at my sponsoring Rotary Club and be involved in up to 16 hours of volunteer time at their community project(s), following my attendance at RYLA

I understand that:
• Rotary and Doxa strives to create a positive and fun experience for all events and unacceptable behaviour such as bullying, abusive language, negative attitudes will not be tolerated.
• I may be evicted from the conference due to misconduct and/or insolance at the discretion of Doxa and the RYLA committee. Transport home will be at my own cost
• Any photos taken throughout the conference may be used for marketing and promotional purposes by Rotary International and the Doxa Youth Foundation.
• Mobile phone usage will be restricted out of respect to our professional, volunteer speakers and you may be required to hand your phone into the conference supporters. Mobile phone reception is also very poor in the area for all providers, including Telstra.
• If I have attended the Rotary Youth Leadership Award before in any location around the world (this includes other in any Rotary district, or at multi-district and international RYLA events) that I will be liable for the full RYLA fee. Sponsorship is not available if I have attended before.
• At the discretion of the RYLA committee, I may be liable for a $500 cancellation fee if I indicated I have time off and remove myself from the conference within a month of the start date.

I agree to the RYLA EOI and Conference Terms.

Release and Indemnity*

I, the above named applicant of the above address am aware and acknowledge that participating at the Rotary International District 9790 Rotary Youth Leadership Award (RYLA) involves inherent risks, including the risk of injury to life or death and damage to property and in undertaking such activities, I do so at my own risk.

I am also aware that it is a condition of participation at RYLA that the Doxa Youth Foundation (Doxa) and Rotary International (Rotary), their officers and employees, agents and volunteers are released by me from all liability howsoever arising from injury or damage to both property and person howsoever caused (whether fatal or otherwise) arising out of my participation at RYLA whether or not such injury or damage is due to any negligent act, breach of duty, default and/or omission on the part of Rotary and/or Doxa, their officers and employees, agents or volunteers.

I indemnify Doxa and Rotary, their officers and employees, agents and volunteers against all loss, damage and expenses (including legal costs on a solicitor and own client basis) arising out of or in connection with any claims, actions, proceedings or demands of any kind arising directly or indirectly as a consequence of my participation at RYLA.

In the case of an emergency I authorise Doxa and/or Rotary, where I am unable to be consent, to arrange for me to receive medical or surgical treatment as deemed necessary. I also consent to undertake any payments or reimburse costs which may be incurred for medical attention, ambulance transport and medication while I am in Doxa and/or Rotary’s care.

I acknowledge and agree that my participation at RYLA is as a consequence of my own free will and desire and that I have read and understood the above warning, release and indemnity.

I warrant that I am 18 years of age or older and am lawfully able to enter into this above release and indemnity.

I agree to the Release and Indemnity.

Privacy statement*

Rotary International District 9790 (Rotary) and the Doxa Youth Foundation (Doxa) will collect and store the information you voluntarily provide. The information will be stored in a manner so that it will only be accessed by authorised Rotary Volunteers and Doxa staff, and subject to privacy restrictions. The information is collected to assist with the RYLA application process and management of the conference. Some of this information will also be provided to Rotary Clubs to provide sponsorship for your place at the conference and to medical professionals where necessary.

Rotary and Doxa are committed to protecting the privacy and confidentiality of your personal information. Our privacy policies adhere to the National Privacy Principles, as required under the Privacy Act 1988. A copy of our privacy policies are available online at https://ryla9790.org.au/privacy/ and http://doxa.org.au/privacy-policy/.

We use Microsoft 365 to collect and store your information; for information about the security of Microsoft 365 see: Privacy at Microsoft.

I agree to the privacy statement.

Media consent

Rotary International (Rotary) and the Doxa Youth Foundation (Doxa) would like your consent to take photos and/or video you at the Rotary Youth Leadership Awards conference.

During the event you may be photographed or videoed in activities such as:
• attending this program or event
• talking about the program listed above

Consent is when you agree to something.

You are giving us consent to use these photos or video:
• on our websites and social media
• in information or advertising about the Doxa Youth Foundation and/or Rotary International
• in newsletters or other communications to the public

Your privacy
Photographs and film of a person that may be capable of identifying the person may constitute a collection of ‘personal information’ under Australian privacy law. Rotary and Doxa value the privacy of every person and must comply with Australian privacy law when collecting and managing all personal information.

Ownership and Reproduction
Copyright in the images will be wholly owned by Rotary and Doxa. This means that Rotary and Doxa may use the images in the ways described in this form without notifying, acknowledging or compensating you.

What you are agreeing to
• you have read this information
• you give us consent to take photos or video of you
• you understand that we may use the photos or video of you in the ways we list above
• your consent starts from the date you submit this form.

Withdrawing your consent
If you want us to stop using the photos or video of you, you must tell us by emailing info@ryla9790.org.au and info@doxa.org.au.

We will not use them again, but we may not be able to remove them from things that have already been published.

I agree to the media consent.

Signature*

Please sign here that you have read and accept the RYLA EOI and Conference Terms, Release and Indemnity, Privacy Statement, and Media Consent.

EOI Fee

Price:

Total

Payment*

MasterCard

Visa

Supported Credit Cards: MasterCard, Visa

Card Number

Expiration Date Month Year

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