District 11 A-1 Convention Registration

DISTRICT 11 A-1 CONVENTION REGISTRATION Embassy Suites by Hilton 850 Tower Dr, Troy, MI, 48098 APRIL 21-23 2017 Please use one sheet for each person in your group/family!

Name______*Guest______Lion___Lioness ___Leo___

*If you are a guest please note who you are the guest of ______

Club______District______

Address______City______

Zip______Phone ______Cell ______

E-Mail Address______

Please indicate highest Lions Office held ______

Current President___ Incoming President___ New Member___

 Is an American Sign Language Interpreter needed? Yes No (Please circle)  Are wheelchair seating/accommodations needed? Yes No (Please circle) NEW MEMBER REGISTRATION FEE (became a member after April 1, 2017) $ NO COST - 0

Registration Fee For LIONS in District ($10.00) $______NOTE: If you do not attend convention and only come to vote you must pay this fee

Registration Fee (NON-LIONS/GUESTS, ($10.00) $______

Saturday Banquet $30.00 each ___ chicken ____Beef ___ Vegetarian $______

Extra Donation towards the convention (this is opt) $______

Saturday Cabinet/Business Meeting (are you attending) ______check off Sunday Elections (No cost -Please RSVP your attendance) _____ check off Friday evening Meet Mix and Mingle (Membership-Fellowship ) ______check off

Total Enclosed Deadline on or before April 15th $______Make Check Payable to: District 11 A-1 Mail form and full payment to: Lion Shirley Kelly 19712 Cheyenne Detroit, MI 48235

For additional information please contact Lion Shirley Kelly at 313-706-9902 or by email at [email protected] Deadline On/Before April 15, 2017. Postmarks of April 15th will be accepted!