Competition Entry Form

Rotary Club of Centreville, Maryland
Full Name

First Name Last Name
Organization
Title
E-mail
Phone
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Please gve details about your organization, 100 words or less
Entry Fee Payment
Check One

We will mail a check for $25.00 to Centreville Rotary, P.O. Box 533 Centreville, MD 216 We will pay for registration at the Rotary's Square Store https://centreville-rotary-club.square.site/product/looselipsync/3
Provide a link to your video YouTube.*
Should be Empty: