The Rocky Mountain District of Key Club International presents: The 65th Annual District Convention, April 1-3, 2016 Sheraton Denver West Hotel Name of Key Clubber: _____________________________________Grade: _____ Division __________ Key Club of: ______________________________________________ Office currently held: __________ Address: ______________________________ City: ______________ State: _________ Zip: ____________ Phone: (___) ____-________ Email: __________________________________________________________ Adult Chaperone (Required): _____________________________________________________________ Emergency Contact: __________________________________________ Phone: (___) ____-_________
IMPORTANT, Please read the following: 1. Use one form per attendee 2. Appropriate payment, in full, must accompany this form. Additional arrangements can be made with the District Administrator. 3. Any registration received after March 11, 2016 will require a $15.00 late fee. Cancelation Policies: 1. All cancelations must be made in writing on or before March 18, 2016 to ensure a complete refund. Any cancellation received after this date is subject to a $50.00 penalty. 2. NO refunds will be granted after March 25, 2016. Registration Fees: 1. Registration includes: 2 nights of lodging, convention shirt, entertainment (including a talent show that YOU can star in), a dance, key note speaker, workshops, and 2 meals (K-Family Luncheon and Farewell Brunch) Rooming Arrangements: If no rooming specified, registrant will be placed in a quad; each price is per registrant. (Check one.) ___Quad: $225 ___Triple: $243 ___Double: $273 ___Single: $381 ___ Quad Freshman $201
Meals: Saturday K-family Luncheon Meal options: (Check one.) ___ Beef ___ Salmon ___ Pasta (vegetarian) Check the following that apply. I am: ___ Male ___ Female ___ Key Clubber ___ Advisor ___ Parent ___ Builders Club ___Circle K ___ Kiwanian ___ Other, Please specify _______________________ T-Shirt Size: Circle one
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Send form to: David Harris, RMD District Administrator, RMDKCAd@aol.com or send to 1641 S. Parfet Ct. Lakewood, CO, 80232. If you any questions, feel free to call David Harris at 720.341.5064. For more information on District Convention visit rmdkeyclub.org or join the 2016 Rocky Mountain Key Club Convention page on Facebook. I, as a member of the RMD Key Club, agree to abide to the Key Club Code of Conduct; if I do not abide by the rules I understand that I can be excluded from this convention. Student Signature _______________________________________
Parent / Guardian Signature ____________________________________________