2010 ANNUAL DISTRICT CONVENTION

Time and Dates: May 13 though May 16

NOTE: A SEPARATE FORM MUST BE USED FOR EACH EXCHANGITE

Everyone who is planning to attend the Annual Conference of the Florida District Exchange Clubs must fill out and return this form (or print this form) with your check or credit card information.  This form MUST be returned as soon as possible to the address at the bottom.  For questions call Kathy Mize at 727-631-1778.

THE COMMITTEE WILL NOT ACCEPT REGISTRATIONS AT THE CONFERENCE.

Name: ________________________________________                       ____________________________________________________

                                                                                                                                  Spouse’s Name ONLY IF ATTENDING ANY FUNCTIONS

Address: ______________________________________                        ____________________________________________________

                                                                                                                                  Guest or Children’s Name ONLY IF ATTENDING ANY FUNCTIONS

C/S/Z:  ________________________________________                        ____________________________________________________

                                                                                                                                  Telephone:

Exchange Club of: _______________________________                        First District Conference:    Yes         No

** Any spouse, Guest or Child attending a meal function must have a paid ticket            Email Address: _____________________________

PLEASE MARK ALL THAT APPLY

District Officer	Yes	No	What Office ________________________________
Club Officer	Yes	No	What District ___________________Year_________
Past District President	Yes	No	What Office ____________________ Year_________
Official Delegate	Yes	No

NOTE:  PACKAGE COSTS ARE PER PERSON

Description                                                                           Quantity                      Before May 1         Quantity                           After May 1              Total                     

Friday Lunch                                                     ________               $30.00                _______                    $35.00               ________

Big Sun Package                                               ________               $175.00              _______                    $185.00             ________

Weekend Package                                             ________              $115.00               _______                   $125.00             ________

All day Saturday thru Sunday Breakfast