Key Club International Convention Registration Form
Rocky Mountain District Hot ‘Lanta Tour: International Convention, July 3 –July 10, 2016 in Atlanta, GA
Name as it appears on official ID_______________________________________ Name for nametag: ___________________ Date of Birth: ____________________________Graduation year__________ Gender: Male ________ Female __________ Key Club_____________________________________________ Office currently held: ______________________________ Address: ________________________________ ___________City:____________________ State: _____ Zip: ____________ Home Phone: (______) ________-_________
Cell phone: _____________________________________
E-Mail: ______________________________________________________
T-shirt size ___________________
Emergency Contact: __________________________________________ Phone: (_____) _______-_____________ Important, Please READ:
1. 2. 3.
All convention attendees must stay at the convention hotel. Reservations must be made through the RMD Administrators using this form. The hotel, airfare, ground transportation by bus, group events, convention registration, and some meals are included. Transportation to Denver is not included. This year’s tour will be by air.
Cancellation Policy: Cancellation requests must be submitted in writing to the District Administrator at the address on this form. In the event of a cancellation every effort will be made to return all payments minus any unrecoverable expenses.
Rooming Arrangements If no rooming specified, registrant will be placed in a quad; each price is per registrant. Key Clubbers who want a double room must find their own roommate who agrees to pay the extra cost of the double room. ____ Single ($2066) ____ Double ($1524) _____ Quad ($1299) Adults may have single or double rooms ONLY. Designated Chaperone: District Administrator Dave Harris, Assistant Administrator, Barb Fuller, and all others appointed by Mr. Harris as required. All adults will be required to have a background check. Needs (Diet, Disability, Other):
Registration Fees: A non-refundable deposit of $500.00 is due by May 10, 2016. A late fee of $50 will be assessed after May 10, 2016. Final payment is due by June 30, 2016.
Total Amount Enclosed $________________ Make all checks payable to: RMD Key Club
We will try to accommodate roommate choice, but by policy we try to limit no more than 2 people from the same school in one room. Desired Roommates 1.) ____________________________ 2.) ____________________________ 3.) ____________________________ I, as a member of the RMD Key Club, agree to abide to the Key Club Code of Conduct. Student Signature ___________________________________________Parent/Guardian _______________________________________ Send form to: Barbara Fuller, RMD Asst. District Administrator, 12933 W. 3rd Pl, Lakewood Co, 80228. For questions contact Barb Fuller at barbaranfuller@aol.com or call 720-341-5074.