+234 805 759 5728 contact@discon9111.org

Registrant / Club Bank Transfer Validation

Registrant / Club Bank Transfer Validation

Please complete the form below carefully.

Registration Category

[select* registration-category “Rotarian” “+70 Rotarian” “Spouse/Guest” “Rotaractor”]

Payer’s Details

Please provide the details of the individual or club representative making this payment.

[text* payer-name] [email* payer-email] [tel* payer-phone] [number* number-paid-for min:1] [group rotary-fields] [text club-name] [text district] [/group]

Payment Details

[text* account-name] [text* bank-name] [number* amount-paid] [date* payment-date] [submit “Submit Validation”]