DCON Registration Form

Page 1

The Rocky Mountain District of Key Club International presents: The 60th Annual District Convention, April 13th­15th, 2012 Sheraton Denver West Hotel Name of Key Clubber: _________________________________Grade: _____ Division __________ Key Club of: __________________________________________ Office currently held: __________ Address: __________________________ City: _____________ State: _________ Zip: ____________ Phone: (___) ____­________ Email: ______________________________________________________ Adult Sponsor (Required): ____________________________________________________________ Emergency Contact: ______________________________________ Phone: (___) ____­_________ IMPORTANT, Please read the following: 1.

Use one form per attendee

2.

Appropriate payment, should accompany this form. Additional arrangements can be made with the District Administrator.

3.

1.

__________________________________ __

2.

__________________________________ __

3.

__________________________________ __

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

Any registration received after March 30, 2012 understand that I can be excluded from this convention. Meals: will require a $15.00 late fee.

Saturday K­family Luncheon Meal options: Student Signature _____________________________ Parent / Guardian Signature ____________________________

Cancelation Policies:

1.

2.

(Check one.)

All cancellations must be made in writing on or before March 30, 2012 to ensure a complete refund. Any cancellation received after this date will be subject to the cost incurred by the RMD Key Club District of any guarantees/expenditures made by that date. NO refunds will be granted after April 12, 2012.

___

Beef

___

Salmon

___

Pasta/Vegetarian

Check the following that apply.

Registration Fees:

1.

Registration includes: 2 nights of lodging, convention shirt, entertainment, a dance, key note speaker, workshops, and 2 meals (K­ family Luncheon and Farewell Brunch)

Rooming Arrangements:

I am: ___ Male

___ Female

___ Key Clubber

___ Advisor

___ Parent

___ Builders Club

If no rooming specified, registrant will be placed in a quad; each price is per registrant. (Check one.)

___ Other, Please specify _______________________

___Quad: $192 ___Double: $237

___Saturday, K­family luncheon $33.00 per person

___Triple: $204 ___Single: $327

Adults may have single or double rooms ONLY. Desired Roommates:

If you are not attending for the full weekend, just for the luncheon or brunch, check one of the following and list how many seats you would like to reserve.

___ Sunday, Farewell Brunch $28.00 per person Total amount enclosed: $ ______________________


Send form to: David Harris, RMD Key Club Administrator, RMDKCAd@aol.com or send them to 1641 S. Parfet Ct. Lakewood, CO, 80232. If you have any questions, please feel free to call Karissa Korf, Convention Chair, kkorf.conventionchair@gmail.com, 970.371.7935, or David Harris at 720.341.5064 For more information on District Convention visit rmdkeyclub.org


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