STATE CONVENTION REGISTRATION FORM

Registration and Event Ticket for 124th State Convention - May 19-21, 2023

*** ONE REGISTRATION FOR INDIVIDUAL OR FAMILY PER FORM ONLY ***

THERE WILL BE NO ON-SITE REGISTRATION. PRE-REGISTRATION ONLY.

Are You A Delegate, Non-Delegate/Alternate, or Guest? *

Delegate

Non-Delegate/Alternate

Guest

Office Use Only (Do Not Use) *

Yes

No

Council Number *

Membership Number

Current Role/Office *

Prefix

First Name *

Last Name *

Suffix

Street Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

GUEST INFORMATION

Enter Any Additional Guest(s) Name, Relation, and which luncheon are they attending on Sunday. 🛈

	First Name	Last Name	Relation	Enter Men or Ladies Sunday Luncheon
1	First Name	Last Name	Relation	Enter Men or Ladies Sunday Luncheon
2	First Name	Last Name	Relation	Enter Men or Ladies Sunday Luncheon
3	First Name	Last Name	Relation	Enter Men or Ladies Sunday Luncheon
4	First Name	Last Name	Relation	Enter Men or Ladies Sunday Luncheon

CONVENTION REGISTRATION

A. You MUST Select Bundle Below

Convention Bundle: Convention Book, Name Tag, Ohio State Pin, Souvenir, Awards Presentation & Friday Night Party, State Deputy Banquet & Sunday Men's Luncheon (N/C)

B. You MUST Select a Bundle Below (includes PayPal Fees)

Convention Bundle: Convention Book, Name Tag, Ohio State Pin, Souvenir, Awards Presentation & Friday Night Party, State Deputy Banquet & Sunday Men's Luncheon ($105)

A. Enter the number (0-4) of Guest Bundles

Guest Convention Bundle: Convention Book, Name Tag, Ohio State Pin, Souvenir, Awards Presentation & Friday Night Party, State Deputy Banquet & Sunday Luncheon (N/C)

B. Enter the number (0-4) of Guest Bundles (includes PayPal Fees)

Guest Convention Bundle: Convention Book, Name Tag, Ohio State Pin, Souvenir, Awards Presentation & Friday Night Party, State Deputy Banquet & Sunday Luncheon ($105)

List Any Dietary Restrictions

GOLF TOURNAMENT

Enter # Golfers Paying For (Includes PayPal Fees)

Friday: Monsignor Krispinski Golf Tournament ($73)

Includes: Coffee & Donuts, 18-Holes, Half Cart, and Box Lunch at the Turn

Are you solo or playing with others?

Solo. Please pair me with someone.

I would like to play with those listed below.

Golf Players Info

	First Name	Last Name	Phone	Email
2	First Name	Last Name	Phone	Email
3	First Name	Last Name	Phone	Email
4	First Name	Last Name	Phone	Email

EUCHRE TOURNAMENT

Enter Number Playing Euchre

Friday: KofC Insurance Agencies Euchre Tournament ($0)

Do You Have A Partner?

Yes

No

Euchre Partner Info

	First Name	Last Name	Phone	Email
2	First Name	Last Name	Phone	Email

STATE COUNCIL ROOM INFORMATION

Please indicate your arrival and departure dates from the State Convention below.

Arrival Date +

Departure Date +

FOR OFFICE USE ONLY

Payment Method

Received Date +

Check Number/CC Transaction ID

Amount

Comments

Table Number