Please use this form to register for NJ Circle K District Convention 2022
March 4th - 6th, 2022
Rutgers University Inn and Conference Center
178 Ryders Lane, New Brunswick, NJ 08901
Note: Use the form navigation at the bottom of the page if you have to go back to any questions on previous pages in the form. Do not use your web browsers back button or you may have to resubmit your registration. Also, if you refresh the page at any time while filling it out, you may have to start over from the beginning. If you are staying over at the hotel for any nights, please have your Medical and Insurance information available because you will need it to fill out the Medical portion of the form.
Unfortunately, there will be no refunds for the event once you have completed your registration.


New Jersey Circle K District Convention

Please note the current COVID-19 Prevention/Health and Safety Measures:

New Jersey Circle K has adopted the meeting guidelines of the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC). We intend to meet or exceed every rule for pre-meeting testing and preparation, follow guidelines for suggested spacing and social distancing during meals and meetings, and offer limited access to only those individuals who need to attend. 

  1. All attendees must attest that they are fully vaccinated and provide proof of vaccination OR must recieve a COVID-19 negative PCR test taken within 72 hours of the event. Attendees must provide all documentation at the time of checking into the conference and remain compliant with the published COVID-19 protocols of Rutgers University New Brunswick Campus and the Rutgers University Inn and Conference Center. Protocols for the event may be updated at any time and all registrants will be informed of any changes in requirements to attend the conference.
  2. All attendees attending the meetings shall sign a waiver of COVID-19 claims.
  3. Any attendee who has tested positive in the last 14 days for COVID-19 is prohibited from attending the conference meetings unless they provide proof of two negative tests since contracting COVID-19.
  4. Any attendee who is not fully vaccinated and has been knowingly exposed to an individual who is positive for COVID-19 within 14 days prior to the meetings is prohibited from attending the conference.
  5. All attendees agree to follow all meeting rules and guidelines established by the State of New Jersey, Rutgers University Inn and Conference Center, Rutgers University New Brunswick Campus, New Jersey Circle K, and Circle K International.
  6. Attendees agree to wear face coverings while attending all conference meetings. 
  7. All attendees agree to regularly wash their hands. Hand sanitizer will be supplied at the meetings.
  8. NJ Circle K will coordinate with the hotel and conference center staff to ensure a thorough cleaning of rooms between meetings.

"Fully vaccinated" as defined by the CDC means “I have received my complete vaccine regimen (2 shots for Pfizer, Moderna or AstraZeneca, or 1 shot for Johnson and Johnson), and 14 days or more has passed since my final shot.” These Health and Safety Measures are subject to change.

Health and safety protocols dictate that each person must separately register for the 2022 NJ Circle K District Convention. We're sorry for any inconvenience this may cause.


The individual named below (referred to as "I" or "me") are members or guests of Circle K International, Inc, Kiwanis International, Inc, or Key Club International, Inc, (the "Company") and desire to participate in-person in Circle K meetings/conferences in March 2022 in New Brunswick, NJ (the "Activity"). As lawful consideration for being permitted by the Company to engage in the Activity, I agree to all the terms and conditions set forth in this agreement (this "Agreement").

I am aware of the highly contagious nature of bacterial and viral diseases including but not limited to the 2019 novel coronavirus disease (COVID-19 (collectively, the "Disease") and the risk that I may be exposed to or contract the Disease by engaging in the Activity. I understand and acknowledge that such exposure or infection may result in serious illness, personal injury, permanent disability, death, or property damage. I acknowledge that this risk may result from or be compounded by the actions, omissions, or negligence of others, including Company employees. I understand that while the Company has implemented preventative measures to reduce the spread of the Disease, the Company cannot guarantee that I will not become infected with the Disease or other infectious diseases while engaging in the Activity and that engaging in the Activity may increase my risk of contracting the Disease. NOTWITHSTANDING THE RISKS ASSOCIATED WITH THE DISEASE, I ACKNOWLEDGE THAT I AM VOLUNTARILY CHOOSING TO ENGAGE IN THE ACTIVITY WITH KNOWLEDGE OF THE DANGER INVOLVED. I HEREBY AGREE TO ACCEPT AND ASSUME ALL RISKS OF PERSONAL INJURY, ILLNESS, DISABILITY, DEATH, OR PROPERTY DAMAGE RELATED TO THE DISEASE, ARISING FROM ENGAGING IN THE ACTIVITY, OR TRAVELING TO PARTICIPATE IN THE ACTIVITY WHETHER CAUSED BY THE NEGLIGENCE OF THE COMPANY OR OTHERWISE.

I hereby expressly waive and release any and all claims, now known or hereafter known, against the Company, and its officers, directors, employees, agents, affiliates, members, successors, and assigns (collectively, "Releasees"), on account of injury, illness, disability, death, or property damage arising out of or attributable engaging in the Activity and being exposed to or contracting the Disease, whether arising out of the negligence of the Company or any Releasees or otherwise. I covenant not to make or bring any such claim against the Company or any other Releasee, and forever release and discharge the Company and all other Releasees from liability under such claims.

I am familiar with federal, state, and local laws, orders, directives, and guidelines related to the Disease, including the Centers for Disease Control and Prevention (CDC) guidance on the Disease. I will comply with all such orders, directives, and guidelines while engaging in the Activity, including, without limitation, requirements related to hand sanitation, social distancing, and use of face coverings. I will also follow all instructions of the Company while engaging in the Activity.  I agree not to participate in the Activity if I am experiencing symptoms of the Disease, such as cough, shortness of breath, or fever, if I have a confirmed or suspected case of the Disease, or have come in contact in the last 14 days with a person who has been confirmed or suspected of having the Disease, unless I have been fully vaccinated as defined by the CDC.  “Fully vaccinated” means that you have received the full vaccine regimen (2 shots for Pfizer and Moderna and 1 shot for Johnson and Johnson), and more than 14 days has passed since your final shot. 

I shall defend, indemnify, and hold harmless the Company and all other Releasees against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties, fines, costs, or expenses of whatever kind, including reasonable attorney fees, fees, and the costs of enforcing any right to indemnification under this Agreement, and the cost of pursuing any insurance providers, incurred by/awarded against the Company or any other Releasees in a final judgment, arising out or resulting from any claim of a third party related to the Disease due to my engaging in the Activity.

This Agreement constitutes the sole and entire agreement of the Company and me with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter. If any term or provision of this Agreement is invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other term or provision of this Agreement or invalidate or render unenforceable such term or provision in any other jurisdiction. This Agreement is binding on and shall inure to the benefit of the Company and me and our respective successors and assigns. All matters arising out of or relating to this Agreement shall be governed by and construed in accordance with the internal laws of the State of New Jersey without giving effect to any choice or conflict of law provision or rule whether of the State of New Jersey or any other jurisdiction.

Unfortunately, you must sign the Covid Waiver Release Form and agree to the guidelines set forth for the 2022 NJ Circle K District Convention to attend.
By clicking "next" below, you will be brought to the end of the form and your registration will not go through. Please go back, review and sign the form.

For more information regarding the event please contact:

District Governor Alyssa Joyce at or Conventions & Conferences Chair Chiara Fune