Convention
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| CONVENTION REGISTRATION FORM DISTRICT 36-O February 26 & 27, 2010 Holiday Inn-Portland South 25425 SW 95th Avenue Wilsonville, OR 97070 Phone: 503-682-2211 Last Name _____________________________First Name _______________________Badge Name ___________________ PLEASE PRINT IF DIFFERENT FROM 1ST NAME Mailing Address ¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬________________________________________________________-______________________________ Number Street Apartment City State ZIP Home Phone ______________ Business or Cell Phone_______________ e-Mail __________________________________ IMPORTANT SHOULD WE NEED TO CONTACT YOU Lion ____ Lioness ____ Leo ____ Guest ¬¬¬¬_____ 1st Timer ____ New Member ____ Club Name _______________________________________________________________ District O--- R---E---G PLEASE CIRCLE ONE Current Elected Office ___________________________________________________ PID_____ PCC ____ PDG ____ REGISTRATION FORMS AVAILABLE ON LINE: Hospitality Book-Included Registration and meals (through February 15, 2010) $90.00 $____________ After February 16, 2010 $110.00 $____________ NO MEALS SOLD AFTER FEBRUARY 20, 2010 NO MEAL TICKETS WILL BE AVAILABLE FOR PURCHASE ON SITE REGISTRATION FEE ONLY: (All attendees must register) $25.00 $___________ The meals at this convention will be Friday Race Night, Saturday lunch, Saturday Banquet Individual Meals: Friday Race Night $ 30.00 Saturday Luncheon $ 25.00 Saturday Banquet $40.00 Individual Meals Total $____________ TOTAL $============ Special needs: Vegetarian ______ Diabetic _____ Other _________________________________ REFUNDS: None prior to the Convention. Request refunds in writing to Nancy Lockett, 1611 Irving, Astoria, OR 97103 A $25.00 handling fee will be deducted from all refunds. Requests must be received no later than March 5, 2010. Reservations must be made with hotel. Convention Dress: Casual except for banquet. Friday night: Race gear apparel encouraged. Sat. Banquet: Suits, Dressy, PDGs: White Coat HOW TO REGISTER: Please type or print all information on this form. Only one person per form, please. Attach additional forms and check(s) made payable to: District 36-O CONVENTION SEND TO: PCC Dick Larsen, Registrar 630 SW Philadelphia Way Beaverton, OR 97006 QUESTIONS: Contact: Lion Sunny Pulley at 503-239-7086 or smpulley@comcast.net |
(Click the above link to download the Form in Word Format.)