2010 Capital Kiwanis Midwinter and CKI District Convention
Registration
Attendee Information
Registration Date:
Registration Type:
CKI
Kiwanian
First Name:
Last Name:
Address1:
Address2:
City:
State:
Zip:
Phone (Daytime):
Phone (Evening):
Email:
First Time Attendee:
Badge Name:
Region:
DelMarVA
Hampton Roads
Heart of Virginia
Mason-Dixon
Northern VA
Other
Potomac
Presidential
Southwest VA
-- None Selected --
Division:
1
2
3
4
5
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
Battlefield
Foothills
Metro
Other
Presidential
Ridgeline
Susquehanna
Tidewater-64
Valley
-- None Selected --
Kiwanis or CKI Club:
Office Currently Held:
Club
District
International
-- None Selected --
Office Currently Held:
Club
District
International
-- None Selected --
T-Shirt Size:
L
M
S
XL
2XL
-- None Selected --
Guests / Spouse Information
Guest / Spouse Name:
First Time Attendee:
T-Shirt Size:
L
M
S
XL
2XL
-- None Selected --
Past Kiwanis Office
Capital District
Kiwanis Internationl
Past International Officer
Past District Governor
Past District Trustee
Past Lieutenant Governor
Past Club President
Foundation Life Member
Tablet of Honor
Founders Society
Foundation Board
District Trustee
Current Lieutenant Governor
Tablet of Honor
Hixson Fellowship
Heritage Society
Kiwanis Fellowship
Life Member
Legion of Honor
Carthage-Pullman Society
Sapphire Circle Honorary
Registration Fee Info
Packages (Includes Registration and All Meals / Sessions)
Fee
Quantity
Total
Kiwanian
$150.00
$0.00
CKI
$135.00
$0.00
Guest/Spouse/Alumni
$150.00
$0.00
A La Carte Registrations (Registration Only)
Kiwanian
$50.00
$0.00
Guest/Spouse/Alumni
$10.00
$0.00
A La Carte Meals / Session
Casino Night - Friday 7:30PM
$40.00
$0.00
Kiwanis-Family Breakfast - Saturday 7:30AM
$20.00
$0.00
Leadership Luncheon - Saturday 12:00PM
$25.00
$0.00
Presidents Banquet - Saturday 8:00PM
$40.00
$0.00
Inspirational Breakfast - Sunday 9:00AM
$20.00
$0.00
Registration Fee Totals:
$0.00