4 -2012 International Convention Registration
2
n New Jersey Registration Form * Use this form for 69th Annual International Convention and tour the New Jersey July 1 to July 8, 2012 District Tour Orlando, Florida Please read the following information carefully: *Convention atten dees must stay at the assigned co nvention hotel. Reservations must be made through the New Jersey District using this form. *Attendees room and tax expenses are included in the package price 1. Last Name 2. First Name (for name badge) 3. Member Number 4. District 5. Club Name New Jersey 6. Complete Mailing A ddress 7. City 8. State 9. Postal Code 10. Country NJ USA 11. Telephone 12. Male Female 13. E-mail address ( ) 14. Position in Key Club Faculty Advisor Kiwanis Advisor Guest Parent -Chaprone 15. Designated Chaperone New Jersey District Administrator By fi lling out this fo rm and making the required *This registration form plus the qua d r ate pa yments, you wi ll en sure your reservations at th e de posi t of $600.00 must be re ceived no later designated hotels. You will recei ve writ ten confirmation than May 9 9, 2012 from the New Jersey Dis tri ct with further instructions. * If s ent a fter May 9, 2012 Dep osi t wi ll be 16. Occupancy $625.00 if space is available 18. Depart Philly 7/1/12 19. Arrive home Philly 7/8/12 *Checks should be made payable to: 17. Roomates List up to three roommates. *A complete registration form and deposit Ke y Club members will not be roomed with ad ul ts should be mai le d t o: 1 2 3 (If you do not specify roommates, the NJ District will match you with roommates.) Mr. Hutchinson 20. Please identify any special needs (diet, handicapped access, etc.) Cancellation requests must be submitted in writing to PLEASE NOTE THAT A CONFIRMATION WILL BE the NJ District by May 15. Refunds will be less a SENT TO YOU IN EARLY JUNE AND THE BALANCE $30.00 processing fee. After that date you WILL BE DUE BY JUNE 10, 2012 must find a replacement of the same sex. Cancellation Policy Mr. Ed Hutchinson NJ Key Club Administrator P. O. Box 2381 609-408-2617 or [email protected] *Questions? Contact: Cape May, NJ 082904 Registration Information (circle one) Hotel Reservations Schedule New Jersey District Convention Fees NEW JERSEY DISTRICT KEY CLUB
Transcript of 4 -2012 International Convention Registration
8/2/2019 4 -2012 International Convention Registration
http://slidepdf.com/reader/full/4-2012-international-convention-registration 1/1
n New Jersey Registration Form * Use this form for
69th Annual International Convention and tour the New Jersey
July 1 to July 8, 2012 District Tour
Orlando, FloridaPlease read the following information carefully:
*Convention attendees must stay at the assigned convention hotel. Reservations must be made
through the New Jersey District using this form.*Attendees room and tax expenses are included in the package price
1. Last Name 2. First Name (for name badge) 3. Member Number
4. District 5. Club Name
New Jersey6. Complete Mailing Address
7. City 8. State 9. Postal Code 10. Country
NJ USA11. Telephone 12. Male Female 13. E-mail address
( )14. Position in Key Club
Faculty AdvisorKiwanis Advisor
GuestParent -Chaprone
15. Designated Chaperone New Jersey District Administrator
By filling out this form and making the required *This registration form plus the quad ratepayments, you will ensure your reservations at the deposit of $600.00 must be re ceived no laterdesignated hotels. You will receive written confirmation than May 9 9, 2012
from the New Jersey District with further instructions. * If sent after May 9, 2012 Deposit will be16. Occupancy $625.00 if space is available
18. Depart Philly 7/1/12
19. Arrive home Philly 7/8/12 *Checks should be made payable to:17. Roomates
List up to three roommates. *A complete registration form and deposit
Key Club members will not be roomed with adults should be mailed to:123
(If you do not specify roommates, the NJ District will
match you with roommates.) Mr. Hutchinson20. Please identify any special needs (diet,
handicapped access, etc.)
Cancellation requests must be submitted in writing to
PLEASE NOTE THAT A CONFIRMATION WILL BE the NJ District by May 15. Refunds will be less a
SENT TO YOU IN EARLY JUNE AND THE BALANCE $30.00 processing fee. After that date you
WILL BE DUE BY JUNE 10, 2012 must find a replacement of the same sex.
Cancellation Policy
Mr. Ed Hutchinson
NJ Key Club Administrator
P. O. Box 2381
609-408-2617 or [email protected]
*Questions? Contact:Cape May, NJ 082904
Registration Information
(circle one)
Hotel Reservations
Schedule
New Jersey District Convention Fees
NEW JERSEY DISTRICT KEY CLUB
