dcon registration form

The Rocky Mountain District of Key Club International presents:The 60th Annual District Convention, April 13th-15th, 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 attendee2. Appropriate payment, should accompany

this form. Additional arrangements can be made with the District Administrator.

3. Any registration received after March 30, 2012 will require a $15.00 late fee.

Cancelation Policies:

1. 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.

2. NO refunds will be granted after April 12, 2012.

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:

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

___Quad: $192 ___Triple: $204 ___Double: $237

___Single: $327

Adults may have single or double rooms ONLY.

Desired Roommates:1. ____________________________________2. ____________________________________3. ____________________________________

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

___ Other, Please specify _______________________

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.

___Saturday, K-family luncheon $33.00 per person

___ 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

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 ____________________________