Registration

Please use this form to register for NJ Circle K INSIGHT 2023

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. Please have your Payment, Medical and Insurance Information available because you will need it to fully register for the event.

THE EARLYBIRD REGISTRATION PRICE IS $145 AND WILL END ON FRIDAY, OCTOBER 20th, 2023 AT 12PM

THE REGULAR REGISTRATION PRICE IS $150 AND WILL END ON FRIDAY, OCTOBER 27th, 2023 AT 12PM

Please make sure you select the correct payment option on the form

If you are paying by Credit/Debit Card/Bank Account:

If you would like to pay by Credit/Debit Card/Bank Account, you will be able to do so through Paypal via this form. All payments made via PayPal include service fees.

If you are paying by Check:

Please make checks out to New Jersey Circle K and mail them to:

District Administrator Mike Olivo

45 Sunset Dr.

Voorhees, NJ 08043

For Earlybird Registration, Please have your check postmarked no later than Friday, October 20th, 2023 or your registration will be void.

For Regular Registration, Please have your check postmarked no later than Friday, October 27th, 2023 or your registration will be void.

All checks should be postmarked by these dates unless otherwise approved by District Administrator Michael Olivo, who can be contacted at michaelolivo.cki@gmail.com

If you are paying by check for more than just yourself, please include a list of names of those you are paying for.

Earlybird Registration - To Receive the Discount, You Must Register Before 12pm on Friday, October 20th *

Paying By Check: $145.00

Paying By Credit/Debit Card/Bank Account: $151.00 (includes service fees)

I am registering for NJ Circle K INSIGHT as a: *

Circle K Club: *

If you selected "other", please list your Circle K Club Name here:

Kiwanis Club Name: *

Kiwanis Club Name (If Applicable):

For name badge purposes, Please list your preferred pronouns (if applicable):

First Name *

Last Name *

Street Address *

Address Line 2

City *

State *

Zip Code *

Phone Number *

Email Address *