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2014 dcon registration form

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Instructions and information Registration fee and submission Registration fee if postmarked by February 8th, 2014:  Quad ($165) Registration fee if postmarked after  February 8th, 2014: Quad ($195) Cancellation policy Club Name Division Person completing form Contact phone # • Checks must be written out to “Carolinas District Circle K,” and full pa yment mus • If you ar e a member of a Ci rcle K c lub, your registrati on choice wi ll be depen • If possible please send single club check with total amount indicated on this Amy Brow 108 Shadowood Dr Chapel Hill NC, CAROLINAS DISTRICT DISTRICT CONVENTI 53rd Annual C ar ol inas Di str • This form along with the Housing Form must be received by 11:59 pm o n F eb ru ary 8 confirmation of registration will be sent to the provided e-mail address. • Please fill out the form below with each registrants information.   A   d   d   r   e   s   s   :    P    h   o   n   e     N   u   m    b   e   r   : • Pleas e ver ify w ith your club the r oom ty pe for which you a re allowed to regist a Triple). See the Housing Form for more details. • Al l re gis tra tio n ca ncel lat ion s mu st be ma de i n wr iti ng t o Amy Brown, by l etter or e- • Registration cancellations received  by Februa ry 12th, 2014  wi ll r ecei ve a r ef un registration cancellations received after February 12th, 2014.   G   e   n   d   e   r   :     M   /    F ATTENDEE EMAIL First name & Last name (as it will appear on name tag) (confirmation email will be sent to each individual registered)   A   d   d   r   e   s   s   :    P    h   o   n   e     N   u   m    b   e   r   :   G   e   n   d   e   r   :     M   /    F

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