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.