District 66 Spring Conference 2015
2015 District Spring Conference: May 8 - 9, 2015
Crowne Plaza
555 E Canal St, Richmond, VA 23219
Registration Form
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required field
Name
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First
Last
Address
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City, State, Zip
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Contact Phone Number
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Email
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Home Club Name
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Home Club Number
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Toastmaster Member
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Yes
No
Club Officer. Select One.
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President
VP Education
VP Membership
VP Public Relations
Secretary
Treasurer
Sergeant-at-Arms
None
Communication Level
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TM
CC
ACB
ACS
ACG
DTM
None
Select "None" if not applicable.
Leadership Level
*
CL
ALB
ALS
DTM
None
Select "None" if not applicable
First Timer
*
Yes
No
Current District Officer (Position)
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Enter "None" or "N/A" if not holding position.
Enter "None"or "N/A" if not holding position
Past District Governor
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Yes
No
Current International Director
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Yes
No
Past International Director
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Yes
No
Non-Toastmaster Guest
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Yes
No
Please provide the name of the Toastmaster who invited you and the name of their club (if known)
Name (person inviting you)
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Name of the Club
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Conference Packages
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A. Full Member Package with Meals $99
B. Full Guest Package with Meals $89
C. Registration, workshop and contests only NO MEALS $25
D/E. Guest Registration, workshop and contests only E. NO MEALS $12
F. Friday night Toastmaster’s 90th Anniversary Dinner, registration, workshop and contest $50
G. Saturday Breakfast Registration, workshops $35
H. Saturday Lunch registration and workshops $45
I. Saturday Dinner Registration , workshop and contest $50
Meal Selection
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Friday Night Vegetarian
Friday Nigh Seafood
Friday Night Grilled Chicken
Saturday Lunch Vegetarian
Saturday Lunch Grilled Chicken
Saturday Lunch Grilled Seafood
Saturday Dinner Vegetarian Delight
Saturday Dinner Seafood over Wild Rice
Saturday Dinner Lemon & Basil Chicken
5K Run
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Yes
No
Fill out below if you have special needs
*
Refund/Cancellation
:
Request for refund or cancellation must be in writing, e-mailed or mailed with a
postmark date no later than April 30, 2015 (12 midnight EST) to the District Treasurer, Kim Powell,
[email protected]
Click "NEXT >>" button below to go to Payment page to make payment and finalize the registration.
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