Lion February 2014 : Page 46

 &#1c;&#1a;WK$QQXDO/LRQV&OXEV,QWHUQDWLRQDO&RQYHQWLRQ )ULGD\&#0f;-XO\±7XHVGD\&#0f;-XO\&#1b;&#0f;
‡7RURQWR&#0f;2QWDULR&#0f;&DQDGD &RQYHQWLRQ5HJLVWUDWLRQDQG+RWHO5HVHUYDWLRQ)RUP Deadlines  ͻ May 1, 2014: Deadline for advance registration and hotel reservation. Registrations after this date will be processed in Toronto. ͻ May 1, 2014: Deadline to receive a refund for a registration cancellation. ͻ May 16, 2014: Deadline to receive a refund for a hotel room cancellation. REGISTRANT INFORMATION  Please type or print name as it appears on passport/photo ID .  First Name ___________________________________ Address ______________________________________ Postal Code ___________________________________ Daytime Phone ________________________________ Family (Last) Name _____________________________ City ____________________________________ Country ________________________________ E-mail _____________________________________________________________________________ … Lion … Lioness Badge/Call Name ___________________ State/Province _________________________ … Lion: Club No. _____________ Membership No. ____________ District _______ Title _________________________________ COMPANION: First Name ______________________ Family (Last) Name _____________________________ Badge/Call Name ___________________ … Lion … Lioness … Guest … Lion: Club No. _____________ Membership No. ____________ District _______ Title _____________________________ CHILD: First Name ______________________________ CHILD: First Name ______________________________ Family (Last) Name ______________________________ Family (Last) Name ______________________________ Age _________________ … Alpha Leo Age _________________ … Alpha Leo … This is my/our first LCI convention. … EŽƚŵLJĨŝƌƐƚĐŽŶǀĞŶƚŝŽŶ͕/͛ǀĞĂƚƚĞŶĚĞĚͺͺͺͺͺͺͺͺͺͺͺͺͺͺ … Letter of Invitation (If a visa is required for your country of origin) [Club number must be provided above to verify membership] The plenary sessions are presented in English with simultaneous translation Will you require a headset? No Yes PACKAGE A :  Includes convention registration for each registrant listed above plus one (1) hotel room serviced by shuttle buses during convention. … Before January 10, 2014: … After January 10, 2014: Reservation in delegation hotel … I prefer my delegation hotel … Prefer hotel based on: … room rate of __________ … location near convention center Arrival date ______________ Departure date___________________ Number of Guests in Room: __________ Number of Beds Needed … 1 … 2 Special Requirements: … Non-smoking … Wheelchair Accessible … Other _________________________________________________________ x The Hotel deposit is US$225 for a standard room and US$350 for a suite. The hotel deposit is not the rate but reserves the room. Your deposit will be credited to your hotel bill at checkout. PACKAGE B : … NO ROOM REQUIRED (Registration only for each person listed above.) I/we plan to attend the following event(s): (Must be registered to attend) OPTIONAL TICKETED EVENTS DATE/TIME FEE EVENT July 6/ 15:00-17:00 US $25 Membership Key Award Ice Cream Social (Key holders only) Melvin Jones Fellow Luncheon July 7/ 13:30-15:00 US $60 July 7/ 20:00-22:00 US $100 District Governor/Past District Governor Banquet QUANTITY _________ _________ _________ AMOUNT DUE $__________ $__________ $__________ PAYMENT: Full payment is required with this form. ‚ US currency only. Checks and money orders must be drawn on US banks. ͻKŶůLJsŝƐĂ͕ MasterCard, American Express & Discover cards ĂĐĐĞƉƚĞĚ͘ͻŽŶƚĂĐƚ>/ĨŽƌǁŝƌĞƚƌĂŶƐĨĞƌŝŶƐƚƌƵĐƚŝŽŶƐ͘ REGISTRATION FEES Adult Child (17 and under ) Early Regular Late Package A : Registrations: Ticketed Events: Hotel Deposit: Total Due: … Check (before 10 January, 2014) (11 January through 31 March, 2014) (1 April, 2014 ʹ onsite) US$110 US$150 US$170 Package B : Registrations: Ticketed Events: Total Due: US$10 US$10 US$10 US$__________________ US$__________________ US$___225.00_________ US$__________________ OR US$__________________ US$__________________ US$__________________ … Bank transfer/deposit (copy must be attached to this form) … Visa … MasterCard … American Express … Discover Your name as it appears on the card _______________________________________________ Credit card must be in the name of the registrant. Card Number ___-___-___-___-___-___-___-___-___-___-___-___-___-___-___-____ Exp. Date ____-____ Security code (3 digits) __________ Signature _________________________________________________________________________________ Mail form and payment to: Lions Clubs International ƚƚŶ͗ŽŶǀĞŶƚŝŽŶŝǀŝƐŝŽŶͻϯϬϬtĞƐƚϮϮŶĚ^ƚƌĞĞƚͻ Oak Brook, IL 60523-8842 USA Credit Card and Bank Transfer Payments can be faxed to: (1-630) 571-1689 (If you fax, please do not mail original) Questions? Email us: registration@lionsclubs.org ͻůůŽǁϰǁĞĞŬƐĨŽƌƉƌŽĐĞƐƐŝŶŐĂŶĚŵĂŝůĚĞůŝǀĞƌLJŽĨLJŽƵƌĐŽŶĨŝƌŵĂƚŝŽŶ͘ Please note: Lions Clubs International will be documenting the international convention for promotional purposes. Your participation may be filmed or photographed at this event. Your registration is your consent for use of these images by Lions Clubs International. CRHF2014.EN 9/13

Convention

Using a screen reader? Click Here