National President Booking Form

The Event Details

Start date of the meeting *

End date of the meeting *

Start Time *

End Time *

Type of Meeting *

If Other, please describe

The Club Details

Name of the 41 Club *

Which Region or Organisation

The Venue Details

Venue Name

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone

The Event Information

Dress Code *

If Other, please explain (if Fancy Dress, the theme)

Is this a joint event with Round Table

Yes
No

Is this a mixed event with Ladies Circle

Yes
No

The Speech

What type of Speech is required? *

Duration

Other relevant information regarding speech

Primary Contact

Name *

First

Last

Email *

Phone

Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Accomodation & Travel

Is Overnight accommodation available if required

Yes
No

Please specify type of accommodation

Hotel / Home Hosting details

Please fill out the following form with your credentials: