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17-S District Convention 2012

Registration and Payment

 

Civic Center

Penn & Locust

Independence, KS

 

Map

Convention Motel:

Appletree Inn

201 N. 8th

Independence, KS

Call (620) 331-5500

For room reservations ask for Lions Rate

(70.00 + tax) by March 10th

 

Map

 

Please follow these step:

  1. Fill out the Registration Form and click on Submit to send your registration

  2. Pay for your convention by credit card.  If you do not have a PayPal account click on "Checkout" in your shopping cart and Click on "Don't Have a PayPal Account" to fill out your credit card information.

  3. Or send your check to the address below

 

 

Step 1: Fill out the Registration Form
NAME:  
ADDRESS:  
CITY:  
STATE:  
ZIP:  

CHOOSE ONE:

     Registrant    Delegate    Alternate    Leo
LIONS OR LEO CLUB:  
EMAIL:  
   
GUEST NAME:  
GUEST CLUB:  

CHOOSE ONE:

     Registrant    Delegate    Alternate    Non-Lion
   

 

Choose separate activities or select number of “PACKAGE(S)” and place total on “TOTAL DUE TO DISTRICT 17-S” line at end of form.

 

Save money and attend everything by choosing the Package Deal!!

PACKAGE DEAL

All meals, registration, and tours.

 @ $30.00
       
       
  Number   Total

REGISTRATION FEE:

 @ $5.00
FRIDAY, MARCH 23, 2012      

Independence Historical Museum & Art Center.

6:30 p.m. International Director Reception

 @ $3.00
SATURDAY, March 24, 2012      

Independence Memorial Hall-Civic Center.

Noon Luncheon & Meeting (Sandwiches, salad, cookies, tea & coffee)

 @ $8.50

2:00 pm Little House on the Prairie Tour

(Leave from Civic Center and return to Museum.)

 No Cost  

3:30 pm Independence Historical Museum & Art Center Tour

(Return to Civic Center after tour.)

 No Cost  

6:30 pm District Convention Banquet

Special Guest Speaker: ID Douglas X. Alexander – New York

Meal: Salad, Carved Roast Beef, new potatoes, green beans, rolls

 @ $17.50
       

 

TOTAL DUE TO LIONS DISTRICT 17-S

Make checks payable to District 17-S

or use your credit card below.

$

Click on Submit below..

 

     

 

Step 2: Pay for your convention by Credit Card

 

 

Choose separate activities or select number of PACKAGES.

Quantities can be changed in your shopping cart.

 

MasterCard - Visa - American Express - Discover

If you do not have a PayPal account click on "Checkout" in your shopping cart and Click on "Don't Have a PayPal Account" to fill out your credit card information.

 

Save money and attend everything by choosing the Package Deal!!

PACKAGE DEAL:

 

  

Per person - all meals, registration, and tours

@ $30.00

Per person

 

 

  

 

 

  
REGISTRATION FEE:

 

  

Must accompany registration form. Registration fee is for daytime participants only.

@ $5.00

Per person

 

 

  

FRIDAY MARCH 23, 2012:

 

  

6:30 p.m. International Director Reception

Independence Historical Museum & Art Center. 

@ $3.00

Per person

 

 

  

SATURDAY March 24, 2012:

 

  

Noon Luncheon & Meeting

Independence Memorial Hall-Civic Center

Meal: Sandwiches, salad, cookies, tea & coffee

@ $8.50

Per person

6:30 p.m. District Convention Banquet

Special Guest Speaker: ID Douglas X. Alexander – New York.

Meal: Salad, Carved Roast Beef, new potatoes, green beans, rolls

@ $17.50

Per person

 

 

  

 

 

  

 

 

 

Step 3: Or pay for your convention by check to the following address

 

 

 

Dr. Ray Rothgeb, PDG

P.O. Box 381

Independence, KS, 67301

Email to: rdrothgeb@cableone.net

Phone: (620) 331-0108 (Hm) or (620) 779-1844 (Cell)