Club Name: Kiwanis Club of ________________________________________________

Name ______________________________________Nickname ____________(for badge)

Position or Office 2006-07___________________________________________________

Spouse / Guest Name(s) ____________________________________________(for badges)

Mailing Address ___________________________________________________________

City ___________________________________ State ________ZIP Code _____________

Home Phone (_____) ____________________Work Phone (_____) _________________

Email Address ____________________________________________________________

Do you require special meals? ________________________________________________
If you have any dietary restrictions or requests due to physical, religious, or cultural reasons, it is important that you advice the district office at the time of registration.

Please check all that apply:
___ First District Convention
___ Past Lt. Governor
___ Legion of Honor
___ George F. Hixson Fellow
___ Ted Osborn Fellow
___ Bo's Buccaneer
___ Life Member (Kiwanis International)
___ Life Member (K-T District)

All Kiwanians attending District Convention functions MUST pay the registration fee EXCEPT Youth and/or Sponsored Youth members.

Kiwanians attending CLE Training Only on Friday (8:30am-4pm) do not have to register for convention. This training includes lunch. If planning on staying for any part of convention, convention registration is required.

EARLY BIRD Full Registration with 4 meals ____ EARLY BIRD Registration Only (No Meals) ____ CLE Training ­ Friday 8:30am-4:00pm ____

@ $120 ea = ______ @ $60 ea = ______ @ $30 ea = ______

AFTER July 24, 2007: Full Registration with 4 meals _____ Registration Only (No Meals) _____ Individual Meals(Registration Fee MUST be paid) Saturday Breakfast _____ Saturday Luncheon _____ Saturday Banquet _____ Sunday Breakfast _____

@$130ea=______ @ $75 ea=______ @ $18 ea =______ @ $24 ea =______ @ $30 ea =______ @ $18 ea =______

NON-REGISTERED GUESTS

Saturday Breakfast _____ Saturday Luncheon _____ Saturday Banquet _____ Sunday Breakfast _____

@ $20 ea=______ @ $26 ea=______ @ $32 ea=______ @ $20 ea=______