Make Plans For Diabetes Alert Day 7




НазваниеMake Plans For Diabetes Alert Day 7
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2010 State Convention Registration Form May 13th - 15th, 2010 Ramada Stevens Point Hotel, Stevens Point, WI


Date




Club




District




Contact Person




Phone




Email







EVENT FEES

by

4/15

after
4/15


Registration- Lions, Lioness, Guests

$14

$16

Registration- Children 12-17

$5

$7

Registration- Leos & Children under 12

FREE

FREE

Thursday Golf

$90

$90

Thursday Dinner & Dance at Camp

$18

$20

Friday Luncheon

$15

$17

Friday Dinner - Pride Wild Game Feed

$12

$15

Friday Hospitality

$8

$10

Saturday Breakfast

$12

$14

Saturday Honors Luncheon

$18

$20

Convention Pin

$3

$3




Please Type or Print Clearly & Check All that Apply




Thursday




Friday




Saturday

Pin(s)

Sub-Total








































Name

m Lion

m Lioness

m Lion/Lioness

m Leo

m Guest

m Child 12-17

m Delegate

m Alternate

m 1st Timer

Meals

m Diabetic m Other*

Registration


$

Golf


$

Dinner


$

Lunch


$

Dinner


$

Hospitality


$

Breakfast


$

Lunch


$

$

$

Title








































Name

m Lion

m Lioness

m Lion/Lioness

m Leo

m Guest

m Child 12-17

m Delegate

m Alternate

m 1st Timer

Meals

m Diabetic m Other*

Registration


$

Golf


$

Dinner


$

Lunch


$

Dinner


$

Hospitality


$

Breakfast


$

Lunch


$

$

$

Title








































Name

m Lion

m Lioness

m Lion/Lioness

m Leo

m Guest

m Child 12-17

m Delegate

m Alternate

m 1st Timer

Meals

m Diabetic m Other*

Registration


$

Golf


$

Dinner


$

Lunch


$

Dinner


$

Hospitality


$

Breakfast


$

Lunch


$

$

$

Title








































Name

m Lion

m Lioness

m Lion/Lioness

m Leo

m Guest

m Child 12-17

m Delegate

m Alternate

m 1st Timer

Meals

m Diabetic m Other*

Registration


$

Golf


$

Dinner


$

Lunch


$

Dinner


$

Hospitality


$

Breakfast


$

Lunch


$

$

$

Title








































Name

m Lion

m Lioness

m Lion/Lioness

m Leo

m Guest

m Child 12-17

m Delegate

m Alternate

m 1st Timer

Meals

m Diabetic m Other*

Registration


$

Golf


$

Dinner


$

Lunch


$

Dinner


$

Hospitality


$

Breakfast


$

Lunch


$

$

$

Title










*List special meal needs/food allergies:_____________________________________

MAKE CHECK PAYABLE TO & MAIL TO:

Wisconsin Lions Convention

c/o PDG Dick Schliewe, 1112 N. Lapham St., Oconomowoc, WI 53066

NO REFUNDS AFTER APRIL 30, 2010

CHARGE MY CREDIT CARD ACCOUNT

m VISA m MasterCard m Discover/NOVUS

Card Number :_______ _______ _______ _______

Card Expires: Mo. ____ Yr. ____ 3-Digit Security Code (back of card) ______

Signature: ________________________________________________

TOTAL

ENCLOSED

$

NEWS: 27-A1
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