<p>K E Y C L U B</p><p>International Convention –International Denver Colorado Convention – July 9-15, – San 2008 Antonio, – District Texas Tour July 3-9, 2017</p><p>WI-UM Key Club District Tour - Registration Form Complete the entire form. Mail the registration form along with deposit of $300 Kathy Gillis– WIUM District Administrator – 412 S Pleasant View Rd, Apt F, Plymouth WI 53073</p><p>Please make checks payable to WIUM Key Club</p><p>District Tour Cost: $1175.00 Per Person</p><p>All Registration Forms MUST be received no later than APRIL 7, 2017 with a $300 non-refundable deposit payment</p><p>FINAL PAYMENT RECEIVED - NO LATER THAN MAY 5, 2017</p><p>ATTENDEE INFORMATION – PLEASE TYPE OR PRINT</p><p>Attendee Last Name: ______First Name:______Middle Name______(Full Legal Name as it appears on Photo ID that will be used at the airport for check-in)</p><p>Nickname for Badge: ______</p><p>School/Club Name: ______</p><p>Club/District Position (if applicable) for name badge: ______</p><p>Gender: _____ Male _____ Female Date of Birth: ______Year of Graduation: ______(Gender and Date of Birth required for airline TSA purposes)</p><p>Mailing Address: ______City: ______State: ____ Zip: ______</p><p>Home E-Mail Address: ______</p><p>Home Phone: ______- ______- ______Student’s Cell Phone: ______- ______- ______</p><p>I would like to add on the Natural Bridge Canopy & Zip Line Tour. I understand the price is an additional $25 </p><p>Parent/Guardian: Print Name: ______</p><p>Date: ______Signature: ______</p><p>Cancellation Policy</p><p>30+ days June 4, 2017 Refund (minus $300 non refundable deposit) 29-11 days prior June 5 – June 22, 2017 50% Refund of Registration & Tours/ Airfare is non-refundable (airline ticket is returned to the student to use) 10-0 days prior June 23 – July 3, 2017 No Refund (airline ticket is returned to the student to use)</p><p>Questions, please contact: Kathy Gillis, Key Club District Administrator 920-475-0500 (cell) Best way to reach me is to email to: [email protected]</p>