Registrant Information First Name Last Name Club name Club Number Telephone Fax Email Address City State AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR RI SC SD TN TX UT VA VI VT WA WI WV WY Zip Registrant special disability assistance needs or special dietary needs : Is this the first District Conference attended : click for yes If returning attendee, number of conferences attended : 1-5 6-10 11-20 21-30 More than 30 Conference Registration Type: Full Registration - $ 150.00 A LA Carte Registration (Friday Only) - $ 65.00 A LA Carte Registration (Saturday Only) - $ 90.00 Registration Amount:$0.00 Number of People Attending Golf Tournament : *There is a fee of $ 85.00 per person for the golf tournament. Golf Tournament Fees :$0.00 Names of Golf Tournament Attendees: Guest Information  (Only those attending any conference function) Guest Registration Fees : $0 .00 Total Fees : $.00    Additional Information Check all that apply Club President President Elect Club Secretary Secretary-Elect Past District Gov Assistant Governor District Gov-Elect Dist. Gov. Nominee Treasurer Paul Harris Fellow Benefactor Major Donor Paul Harris Society Spouse Spouse Activities and Sunday Special Tour : (No charges but you must register) Friday Spouses' Activity ( No. of Persons) Saturday Spouses' Activity ( No. of Persons) Sunday Special Family Tour ( No. of Persons)        Add a Guest  First Name    Last Name    Age    Guest Type   Children Spouse Guest   Registration Type   Full Registration A La Carte Registration (Friday Only) A La Carte Registration (Saturday Only)             *Please print this page before you submit.