NAME_______________________________PARTNER______________
(If attending)
Please circle one: Is your partner a Kiwanian? Yes No
ADDRESS________________________________________________
__________________________________________________
CLUB_____________________ Day Time Phone____________________
Email Address:________________________________________________
YES______I WILL ATTEND. NO_______I CANNOT ATTEND.
Please check those items that may apply to you:
____Current Club President ____Incoming Club President
____Current Club Secretary ____Incoming Club Secretary
____First Timer to a Kentucky-Tennessee District Conference
____Past Governor ____KY-TN District Foundation Member
____Member of Sponsored Programs Club (K-Kids, Builders, Key, Circle K)
____Will attend CLUB LEADERSHIP EDUCATION TRAINING
____Will attend LEADER CERTIFICATION TRAINING
EARLY BIRD REGISTRATION #___ x $88.00
= $______
Includes Registration, Saturday Continental Breakfast,
Saturday Lunch Buffet, Saturday Dinner Buffet, and
Sunday Breakfast Buffet.
TO QUALIFY for this $88. EARLY BIRD PACKAGE, PAYMENT
Must be RECEIVED when REGISTRATION is SUBMITTED.
THIS SPECIAL PACKAGE with reduced rates is ONLY
AVAILABLE UNTIL FEBRUARY 8, 2004.
All attendees must pay the registration
| Registration (BEFORE 02/08/2004) | #_____ x $15 = $______ |
| Registration (AFTER 02/08/2004) | #_____ x $20 = $______ |
| Registration (WALK-IN) | #_____ x $20 = $______ |
| Saturday Continental Breakfast | #_____ x $12 = $______ |
| Saturday Lunch Buffet | #_____ x $19 = $______ |
| Saturday Dinner Buffet | #_____ x $34 = $______ |
| Sunday Breakfast Buffet | #_____ x $16 = $______ |
| TOTAL AMOUNT DUE | $______ |
ALL MEALS MUST BE ORDERED IN ADVANCE.
NO MEALS WILL BE AVAILABLE FOR "WALK-INS"
Make check payable to: KY-TN District of Kiwanis International
Mail to:
KY-TN Kiwanis Office
1035 Strader Drive, Suite 150-1
Lexington, KY 40505
Click here for March 5-7, 2004 Conference Program
Click here for March 5-7, 2004 Hotel Registration Information