JANUARY 15-17, 2010
Postmark Deadline	Registration
12/23/2008	$90
12/30/2009	$100

Group Registration

Session 1: JANUARY 2010

FRIday, JANUARY 15 – sunday, JANUARY 17

Registration Procedures:

§ Each school sends in only one group registration per conference. Copy form if you need more space.

§ Refer to the postmark deadlines chart to determine the registration fees for each student.

§ For every seven students from the same school, one sponsor registration is waived.

§ Please register everyone who will be attending from your school.

§ Payment must accompany this form. Check or money order payable to: Weekend of a Lifetime.

§ Refunds cannot be offered after the final postmark date.

§ When conference is not "sold out," registrations may be available on a walk-in basis after the final postmark date.

Organization Key Club Circle K sponsoring kiwanis club:

School School Phone ( ) –

Contact Name Mobile/Home Phone ( ) –

Contact E-mail Address

CONTACT MAILING ADDRESS CITY STATE ZIP CODE

Street

SPONSOR LAST Name - Print EXACTLY as should appear on NAME BADGE FIRST NAME Sex PAYMEnt

1. f m

2. f m

STUDENT LAST Name - Print EXACTLY as should appear on NAME BADGE FIRST NAME Sex PAYMEnt

1. f m

2. f m

3. f m

4. f m

5. f m

6. f m

7. f m

8. f m

9. f m

10. f m

11. f m

12. f m

13. f m

14. f m

TOTAL ENCLOSED: