STATE CONVENTION REGISTRATION FORM

125th State Convention - May 17-19, 2024

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

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

Are You A Delegate? *

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	Attending Luncheon (Y/N)
1	First Name	Last Name	Relation	Attending Luncheon (Y/N)
2	First Name	Last Name	Relation	Attending Luncheon (Y/N)
3	First Name	Last Name	Relation	Attending Luncheon (Y/N)
4	First Name	Last Name	Relation	Attending Luncheon (Y/N)

CONVENTION REGISTRATION

A. Member Bundle

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

B. Member Bundle (includes PayPal Fees)

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

Friday Night Event ONLY ($25)

A. Guest Bundles - Enter a Number Between 1-4.

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

B. Guest Bundles (includes PayPal Fees) - Enter a number between 1-4.

	Guest Convention Bundle: Convention Book, Name Tag, Souvenir, Awards Presentation & Friday Night Party, State Deputy Banquet & Sunday Luncheon ($105)
	Friday Night ONLY ($25)

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

SPECIAL EVENT

Enter # Attending

Saturday: Tour of The Cathedral Basilica of the Assumption and Mother of God Church ($15)

(3 remaining)

STATE COUNCIL ROOM INFORMATION

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

Arrival Date +

Departure Date +

PAYMENT METHOD

Click for Total:

$0.00

Payment Method *