2017 TX-OK District of Kiwanis Registration Form
We are excited you are joining us for District Convention (DCON) 2017 in Abilene, Texas! The registration deadline is July 21, 2017. Registrations received after that date will be assessed an additional $10 administration fee.
SEC. I: GENERAL REGISTRATION INFORMATION
This form is divided into four sections. Section one asks for general information, registration fee, club information, dietary restrictions, t-shirt and pin options and hotel/lodging plans. Section two covers ticketed events. Please see the full DCON agenda at www.txokkiwanisconvention.org for in-depth descriptions of all activities. Section three is only applicable for those registering children. For the children's agenda please visit the website. Section four covers payment.
Current Office, if any:
Is this your first Kiwanis Convention?
Will your spouse attend?
Will your Child(ren) attend?
Is your spouse a Kiwanis member?
Spouse's Current Office, if any:
2017 Registration Fee. 100% club fee is only waived with code. If incorrect or no code is given your registration will NOT be complete.
Individual Member = $75
Kiwanis Spouse = $20
Non-Kiwanis Spouse = $10
100% Club (fee waived with code) = $20
100% Club Spouse/Member (fee waived with second code) = $20
Total Registration Fees:
Are you currently a Governor + Spouse, Governor-Elect +Spouse, Immediate Past Governor +Spouse, Special Guests (like International Trustees or Presidents +Spouse) District Secretary, Treasurer, Office Staff and Meetings Coordinator?
Are you a Past-Governor, 2016-2017 Kiwanis Year Trustee, 2016-2017 Kiwanis Year Lt. Governor, CKI or Key Club Governor?
Street Address Line 2
District of Columbia
Antigua and Barbuda
Bosnia and Herzegovina
Central African Republic
Cocos (Keeling) Islands
Democratic Republic of the Congo
Turkish Republic of Northern Cyprus
Papua New Guinea
Republic of the Congo
Saint Kitts and Nevis
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Sao Tome and Principe
Trinidad and Tobago
Tristan da Cunha
Turks and Caicos Islands
United Arab Emirates
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Is this a cell phone?
Do you want a Kiwanis DCON Pin?
Convention Pin = $5
DCON Pin Quantity:
For the 2017 DCON Local Service Project please bring a new children's book to be donated to local organizations including a brand new Head Start School so pre-K books are highly encouraged. In lieu of a book you may donate $5 to the fund.
Book Donation Quantity:
Do you want a Kiwanis DCON T-shirt? See design at www.txokkiwanisconvention.org.
Adult = $15
Adult T-shirt Quantity:
Do you want a Kiwanis DCON child's t-shirt? Same design as adult.
Child = $10
Child T-Shirt Quantity:
Child T-Shirt Sizes:
Total T-Shirt Cost/Order:
Please indicate your travel/lodging plans. You must make your reservations directly with the hotel and please ask for the Kiwanis DCON rate. Bus service is only available to and from the host hotel: McMElegante Suites located at 4250 Ridgemont Dr. 325-698-1234
McMElegante Suites (Host Hotel)
If "Other" please indicate hotel name or lodging plans:
How many nights will you be staying in Abilene?
If you are staying at the McMElegante Suites will you require transportation to and from the convention activities?
SEC. II: TICKETED EVENTS
PLEASE INDICATE THE NUMBER OF TICKETS YOU WILL NEED FOR EACH EVENT. Please see the full agenda at www.txokkiwanisconvention.org for events and in-depth descriptions of all convention activities. Below are ticketed events only. If you are not attending an event, choose leave blank or when required enter a (0):
Thursday, August 3rd
Pre-Convention Event @ McMElegante Suites (Host Hotel)
Texas Oklahoma Growth Summit & I-LEAD-Club Leadership Education: Learn how to actively grow your club or participate in club leadership training. Price includes lunch, materials and is open to all. (Summit time is from 10am-4pm and I-Lead is 3pm-5pm)
Growth Summit = $20
Growth Summit Quantity:
Friday, August 4th
DCON @ Abilene Convention Center
All Kiwanis Breakfast: Hosted by Past-Lieutenant Governor’s Association. Celebrate our leadership in action.
PLGA Breakfast = $11
Project Eliminate Walk – NEW TIME! Eliminate Walk will be indoors (short walk) directly after Opening Session. There will be one patch per club provided. One Vaccine = One Life Saved! Save 5 Lives - $9 OR Save 10 Lives - $18
SAVE FIVE LIVES = $9
SAVE TEN LIVES = $18
Eliminate Walk Quantity:
Spouses Day Out: "A Taste of the Friendly Frontier." Enjoy a fun-filled day in Abilene, Texas visiting local attractions and sampling various foods from local chefs with an optional wine tasting (additional cost). Leaving from the convention center, 9 am -4 pm. Transportation provided.
Spouses Day Out = $45
Spouses Day Out Quantity:
All Kiwanis Lunch: A time to come together to kick-off convention directly after opening session. Hosted by the TX-OK Foundation. A time of recognition and celebration. There will be a guest speaker.
Friday, All Kiwanis Lunch = $18
Friday, All Kiwanis Lunch Quantity:
Family Fun Night! Let’s all go to the Abilene Zoo. A private event with West Texas BBQ, an up-close look at the wondrous animals, giraffe feedings, live music, a mini-train ride for kids and adults, and lots of old fashioned fun. Children under 3 are free.
Adult = $20
Family Fun Adult Ticket Quantity:
Children (ages three to ten) = $15
Family Fun Child Ticket Quantity:
Saturday, August 5th
DCON @ Abilene Convention Center
Kiwanis Prayer Breakfast: A time of reflection and joy as we give thanks for all we have to be grateful for as Kiwanians. The Layperson of the Year will also behonored. There will be a guest speaker.
Prayer Breakfast = $11
Prayer Breakfast Quantity
All Kiwanis Luncheon: A time when we come together for fellowship, network and learn more about what is going on in the Kiwanis Family. There will be a guest speaker.
Saturday All Kiwanis Lunch = $18
Saturday, All Kiwanis Lunch Quantity
Governor's Banquet: A celebration evening where we look toward our 2017-2018 Kiwanis-Family future. There will be a guest speaker.
Governor's Banquet/Dinner = $25
Governor Banquet Quantity
SEC. III: Children's Registration
Yes! I would like to register a child/teen (ages 3 – 17) for the children’s itinerary. Please note,all children who attend the children activities without a parent must be potty-trained. To see the full children’s agenda please visit the convention website. All meals during the Children’s Program are included in price. (Does not include meals during Kiwanis agenda or Family Fun Night). If adults wish to accompany their children during children's activities, they must pay for their own entrance fees and expenses as they wish. If you are not registering any children please skip to section four.
Children's Agenda/Registration Fees
One Day = $25
Both Days = $45
Children's Registration Fees Quantity
Child 1 Name
Child 1 Age
Child 2 Name
Child 2 Age
Child 3 Name
Child 3 Age
Child 4 Name
Child 4 Age
Child 5 Name
Child 5 Age
Legal Guardian/Parent Name:
Legal Guardian/Parent Phone Number
Emergency Contact Name:
Emergency Contact Phone Number:
Does your child have any special needs, need assistance with medication or food allergies? Please list all allergies. Information is confidential.
"In case of an emergency, we will make every effort to contact the guardians/parents. If the situation is critical and you cannot be reached, we need to have your permission to obtain necessary treatment for your child.“In the event my child/children are the victim of an accident or sudden illness and I cannot be reached by telephone, I hereby authorize Any Sponsors of TX-OK Kiwanis DCON Children’s Activities or Employees/Volunteers of the Boys and Girls Clubs of Abilene, present to take whatever measures are necessary for the emergency treatment of my child. I understand these measures may include:emergency surgery, medication, or whatever is deemed necessary by the attending physician. I fully understand that I am responsible for any expenses incurred as a result of any accident or illness my child may have. I do not hold Any Sponsors of TX-OK Kiwanis DCON Children’s Activities or Employees/Volunteers of the Boys and Girls Clubs of Abilene, responsible for any misfortune which might occur during the DCON Children’s Activities." Please type your name in the box below if you agree.
SEC IV: PAYMENT
Please verify your total is correct before proceeding to PayPal for final payment. You do not have to have a PayPal account and may use a credit card to complete the process; however you will still be directed to PayPal for the transaction.
100% Club Code 1 (Member)
100% Club Code 2 (Member/Spouse)
If you are a Past-Governor, 2016-2017 Kiwanis Year Trustee, 2016-2017 Kiwanis Year Lt. Governor, CKI or Key Club Governor please enter your code here.
Spouse Registration Discount
If you are a Governor + Spouse, Governor-Elect +Spouse, Immediate Past Governor +Spouse, Special Guests (like International Trustees or Presidents +Spouse) District Secretary, Treasurer, Office Staff and Meetings Coordinator please enter your code here.
Notes: Is there anything we need to know?
Total Due. If you are a 100% Club your registration fee due is $0.00 if your club secretary already sent in club's payment. If your code is invalid your registration will not be complete. A max of two 100% club entries per registration can be entered.
This is the amount that will be charged to your credit card via PayPal.
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