2011 MWC Registration Form by ashrafp

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									                           60th ANNUAL MD23 LIONS MID-WINTER CONFERENCE
       FRIDAY, FEBRUARY 4, 2011 THROUGH SUNDAY, FEBRUARY 6, 2011
                    THE HOLIDAY INN, WATERBURY, CONNECTICUT
                                        Come celebrate “The Emerald City”
                             INTERNATIONAL GUEST: International Director Gary Anderson
LION/LIONESS _______________________________________________________ DISTRICT _________
CLUB _________________________________________ OFFICE _________________________________
HOME TELEPHONE ________________________ BUSINESS TELEPHONE _______________________
ADDRESS _________________________________ E-MAIL _____________________________________
CITY _______________________________________________ STATE ______ ZIP ________________
LION/LIONESS/GUEST _______________________________________________ DISTRICT _________
CLUB ________________________________________ OFFICE __________________________________
CHILDREN # _______ NAME (S) ___________________________________________________________
First Name preference on badge(s)           A.   _____________________ B. ____________________
(Please Print)
                             Please use the back of this form for additional names.
    *** Registration ($25.00) is included in all packages and required for any participation, including Friday night.

                                    Meal and Registration Plans                            # Of Persons          Cost

  A.      Saturday Lunch, Cocktail Party, Banquet, Sunday Breakfast, Registration                             @ $127.00

  B.      Saturday Lunch, Cocktail Party, Banquet, Registration                                               @ $105.00

  C.      Saturday Cocktail Party, Banquet, Sunday Breakfast, Registration                                    @ $100.00

  D.      Saturday Cocktail Party, Banquet, Registration                                                      @ $78.00

  E.      Saturday Lunch, Registration                                                                        @ $52.00

  F.      Children 10 & Under – includes Sat. Lunch & Dinner, kids menu (registration                         @ $33.00
          not required)

  G.      Registration only (includes Friday night and all seminars—no meals)                                 @ $25.00

Please note any special dietary needs: _______________________________________________________
To assure a place in the banquet hall please get your registrations in early…. seating is limited.
All registrations must be received no later than January 21, 2011 * ABSOLUTE DEADLINE*
             Please note: No refunds after February 1, 2011.
Please provide an e-mail address for confirmation of your registration___________________________________


                                                                                     Total Amount Due_______________

     Hotel Reservations: Lions Convention Room Rate - $99.00 Per Room /Per Night. Call the Holiday Inn for room
    reservations: 1-203-706-1000 Fax: 1-203-706-1092. Be certain to indicate that you are with the Connecticut Lions
    Mid-Winter Conference. Conference room rate prices are good through January 14, 2011. Be prompt to assure
    obtaining the Conference rates! The Holiday Inn, 3580 East Main St, Waterbury, CT 06705

                   2011 MD23 Mid-Winter Chairman           2011 MD23 Mid-Winter Registration Chairman
                        Armand R LaFleur, IPCC                            CS Joan Eaton
                           9 Gary School Rd                            83 Providence Street
                           Putnam, CT 06260                            Taftville, CT 06380
                 860-928-0376 armand.la.fleur@snet.net           860-204-0194 seaton04@snet.net

    Complete this registration form and enclose with a check to cover the cost of your selections. Make checks payable
    to the ―2011 MD23 Mid-Winter Conference‖ MAIL TO: Registration Chairperson CS Joan Eaton

								
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