Laugh and Learn
Laugh and Learn at the Kiwanis Family Reunion The 99th Wisconsin-Upper Michigan Kiwanis District Convention August 18-20, 2017 • Holiday Inn, Fond du Lac, WI REGISTRATION FORM
Complete and send by July 29th for $0.00 advance registration fee
______________________________________________________ Member Name – First/Last (To use on badge)
__________________________________________________ Non-member/Guest Name – First/Last (to use on badge)
______________________________________________________ Daytime Phone Number
__________________________________________________ Email
______________ Division No.
__________________________________________________ 2016-17 Office Held
____________________________________ Kiwanis Club
Please Note: All Kiwanians in attendance MUST register for the District Convention
After July 29th $20.00 each $ _________
REGISTRATION FEE PER PERSON
Advance $0.00
FRIDAY, AUGUST 18
Number
• CLUB LEADERSHIP EDUCATION
_________
No charge
$ _________
_________
$20.00
$ _________
_________
No charge
$ _________
• LUNCHEON (Deli sandwich buffet)
_________
$15.00
$ _________
• GOVERNOR'S BANQUET (Plated with both 7 oz. Ribeye and Panko Crusted Walleye)
_________
$30.00
$ _________
All Kiwanians that register after July 29th must pay the $20.00 late fee.
Price
Total
(Please register if attending so we know how many to expect)
• KIWANIS FAMILY PICNIC BUFFET (Johnsonville Brats and 1/3 lb. Hamburgers)
SATURDAY, AUGUST 19 • CLUB LEADERSHIP EDUCATION (repeat of Friday’s session) (Please register if attending so we know how many to expect)
TOTAL ENCLOSED
$ 0.00 _______
Please indicate if you require any special needs meals: ________________________________________________________. CHARGE CARD AUTHORIZATION Please Check: ¨ Master Card ¨ Visa ¨ Discover Account Number _____________________________________________________________
Expiration Date _____________
Name on Card (please print) ____________________________________________________
Zip Code __________________
Security Code __________
NOTE: Online registration is available at www.wiumkiwanis.org or total fees must accompany this convention registration form. CHECK PAYABLE TO WI-UM KIWANIS. Mail registration and check to: WI-UM Kiwanis, 571 Center St, Berlin, WI 54923. You may FAX your form with the credit card information to (866) 484-4745. To request a refund please refer to District Refund Policy p8.3.1 at wiumkiwanis.org/district_bylaws.
Complete and send by July 29th for $0.00 advance registration fee
______________________________________________________ Member Name – First/Last (To use on badge)
__________________________________________________ Non-member/Guest Name – First/Last (to use on badge)
______________________________________________________ Daytime Phone Number
__________________________________________________ Email
______________ Division No.
__________________________________________________ 2016-17 Office Held
____________________________________ Kiwanis Club
Please Note: All Kiwanians in attendance MUST register for the District Convention
After July 29th $20.00 each $ _________
REGISTRATION FEE PER PERSON
Advance $0.00
FRIDAY, AUGUST 18
Number
• CLUB LEADERSHIP EDUCATION
_________
No charge
$ _________
_________
$20.00
$ _________
_________
No charge
$ _________
• LUNCHEON (Deli sandwich buffet)
_________
$15.00
$ _________
• GOVERNOR'S BANQUET (Plated with both 7 oz. Ribeye and Panko Crusted Walleye)
_________
$30.00
$ _________
All Kiwanians that register after July 29th must pay the $20.00 late fee.
Price
Total
(Please register if attending so we know how many to expect)
• KIWANIS FAMILY PICNIC BUFFET (Johnsonville Brats and 1/3 lb. Hamburgers)
SATURDAY, AUGUST 19 • CLUB LEADERSHIP EDUCATION (repeat of Friday’s session) (Please register if attending so we know how many to expect)
TOTAL ENCLOSED
$ 0.00 _______
Please indicate if you require any special needs meals: ________________________________________________________. CHARGE CARD AUTHORIZATION Please Check: ¨ Master Card ¨ Visa ¨ Discover Account Number _____________________________________________________________
Expiration Date _____________
Name on Card (please print) ____________________________________________________
Zip Code __________________
Security Code __________
NOTE: Online registration is available at www.wiumkiwanis.org or total fees must accompany this convention registration form. CHECK PAYABLE TO WI-UM KIWANIS. Mail registration and check to: WI-UM Kiwanis, 571 Center St, Berlin, WI 54923. You may FAX your form with the credit card information to (866) 484-4745. To request a refund please refer to District Refund Policy p8.3.1 at wiumkiwanis.org/district_bylaws.
