Stafford Rotary Club

 Chartered in 1924  District 1210      updated 8th April  2022

Stafford Rotary Club

Welcome to  the website of the Stafford Rotary Club, United Kingdom








club officers

Registration form

pony ride

rotary wheels

what is Rotary


Sleep Out 2019

Health Awareness

Food bank





Title Mr Mrs, Miss, M/s

First Name



Post Code

Phone Number

Email address

Confirm email address

Date of Birth ( must be 18 or over)

Medical Information

Any medical information (please declare for your own safety

Any medication required for this condition, if so, please ensure that you carry them with you.

Any dietary requirements / allergies etc

Any disabilities or access requirements

Emergency Contact


Next of kin, family member or friend


I confirm that I wish to enter the “Sleep Out to Kit Out” event and that the information I have given above is correct. I have read and agreed to abide by the terms and conditions of the event accompanying this registration form. I agree that I will seek medical advice from a general practitioner if I am in any doubt as to my physical ability to complete this event. I also confirm that I am aware that any photographs taken during the event may be used to publicise this event and the work of Cannock Rotary Club and the Rotary Club of Stafford.

Signature ………………………………………………………………     Date ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,

To enter this event please print this form.  Complete the form and send it by post to Mr L Lee, White Lodger, Chase Road, Brocton, Stafford, ST17 0TL Tel: 01785 664521 email:

Please indicate how you will pay your £10 registration fee>

I have enclose my registration fee of £10 and a cheque made payable to The Rotary Club of Stafford or I have sent a BACS payment to the Rotary Club of Stafford.

Sort Code : 40 43 03   Account Number: 81396846   Quote reference: “Sleep out”

An official sponsorship form can be found at or you might like to set up your own “Just Giving” or similar on line donation page. Pictures and text to promote your site can also be found on the club’s website.

Sponsorship forms and money should be sent in the same way on competition of the Sleep Out.

Sleep Out to Kit Out  - REGISTRATION FORM