Name:*

Member:*

Yes No

Communication Track Completed:*

CC ACB ACS ACG NA

Leadership Track Completed:*

CL ALB ALS DTM NA

Club Name:

Club Number:

Club Officer Position (if applicable):

District Office Position (if applicable):

Phone Number:*

Email:*

Is this your first time attending a District Conference?:*

No Yes

Do you want to stake an active role organizing the conference by volunteering?:*

Yes No

Will you be spending the night at McCamly Plaza Hotel?:*

Yes, Friday Only Yes, Saturday Only Both Friday & Saturday None

Have you earned your DTM since the Spring Conference or expect to before this conference?:*

No Yes

Name three favorite songs for Saturday Night Sing Along:

Do you have a special talent (magic, clean comedy, dance, theatre, vocal or instrumental music) for our Talent ShowCase?:

Is there anything we can do to help (carpool, room sharing, special seating, dietary needs, etc.)?:

Additional Registration Information:
If you are registering multiple people, please include answers to the questions above - for all.