District 201Q4 Convention 2026 Registration Form

201Q4 DISTRICT Convention 2026 EARLY BIRD Registration Form

Hosted by the Lions Club of Rockhampton Fitzroy River Inc. for District Governor Elect Murray Wegner
EARLY BIRD registrations go into a draw to win a double

SATURDAY DG GALA DINNER TICKET.

Early bird registrations close on 31st March and winner will be drawn on April 1st.

Full registration forms will be available from 1st April 2026.

(We will email you to complete this form in April.)
Note - fields marked with * require an entry to be made

201Q4 District Convention 2026

Where: Gracemere Community Centre, 6-12 Barry Street Gracemere 4702

When: Friday 23rd October to Sunday 25th October 2026

Registrations: Friday 12-4pm and Saturday 8 - 9am

Dress code for Friday Night Meet and Greet– "Demin and Lace"

Saturday Night DG Gala Dinner - "Shimmer and Shine in Rhinestone"
District*
eg 201Q4
Club Name*
e.g. Marlborough & District
Club Number*
eg 12345
Title*
Primary Person Full Name*

First NameLast Name
First Convention*

YesNo
Is this your Early Bird Registration?*

YesNo
Address

Street Address

Street Address Line 2

CityState e.g. Qld

Postcode e.g. 4314
Primary Person Home Number
Please enter a valid Home NumberFormat: (00) 0000-0000.
Primary Person Mobile Number*
Please enter a valid Mobile Number.Format: 0000 000 000.
Primary Person E-mail*
example@example.com
Emergency Contact Name*

First Name EmcyLast Name Emcy
Emergency Contact Mobile Number*
Please enter a valid Mobile Number.Format: 0000 000 000.
Food Options

VegetarianDairy FreeGluten FreeVeganOther
Saturday Lunch Choice*

Pie Beef PlainPie Beef and MushroomPie Cheese and BaconPie Chunky SteakPie Steak Creamy Garlic MushroomPie Pepper SteakPie Curry MinceRoll Spinach and FetaSalad Wrap or SandwichNone
- Title2
- Person 2 Full Name
  
  First Name2Last Name2
- First Convention2
  
  YesNo
- Mobile Number2
  Please enter a valid Mobile Number.Format: 0000 000 000.
- Food Options2
  
  VegetarianDairy FreeGluten FreeVeganOther
- Saturday Lunch Choice2
  
  Pie Beef PlainPie Beef and MushroomPie Cheese and BaconPie Chunky SteakPie Steak Creamy Garlic MushroomPie Pepper SteakPie Curry MinceRoll Spinach and FetaSalad Wrap or SandwichNone
- Title3
- Person 3 Full Name
  
  First Name3Last Name3
- First Convention3
  
  YesNo
- Mobile Number3
  Please enter a valid Mobile Number.Format: 0000 000 000.
- Food Options3
  
  VegetarianDairy FreeGluten FreeVeganOther
- Saturday Lunch Choice3
  
  Pie Beef PlainPie Beef and MushroomPie Cheese and BaconPie Chunky SteakPie Steak Creamy Garlic MushroomPie Pepper SteakPie Curry MinceRoll Spinach and FetaSalad Wrap or SandwichNone
- Convention Costs - Enter the quantities against each item to calculate total cost. NOTE each Cost is shown Per Person. Enter 0 if not required.
- Item Description
- Cost
- Qty*
- Value
- Item2*
- Cost2*
- Qty2*
- Value2
- Item3
- Cost3
- Qty3*
- Value3
- Item4
- Cost4
- Qty4*
- Value4
- Item5
- Cost5
- Qty5*
- Value5
- Item6
- Cost6
- Qty6*
- Value6
- Item7
- Cost7
- Qty7*
- Value7
- Item8
- Cost8
- Qty8*
- Value8
- Item9
- Cost9
- Qty9*
- Value9
- Item10
- Cost10
- Qty10*
- Value10
- Item11
- Cost11
- Qty11*
- Value11
- Item12
- Cost12
- Qty12*
- Value12
- Would you be interested in a bus pickup for the evening events? Cost to be advised.
  
  YesNo
- Need Help? - Contact Convention Secretary
  
  Kathy Barrett ph. 0438 331 265
  
  or email convention.q4@lions.org.au
  
  Registration enquires to Frank Douglas on 0411 634 650 or email frank.douglas@bigpond.com
  
  EFT Payments to:
  
  Lions Club of Rockhampton Fitzroy River Convention 2026
  
  BSB; 034 636 Account no; 289562
  
  Reference = Full Name of Primary Contact
  
  We will contact you in April for full registration details of meals etc.
- Date Submitted
  
  DayMonthYear
  Date
  Hour MinutesAM/PM Option
- Payment Received Date
  
  DayMonthYear
  Date
- Upload Your Payment Confirmation here (Optional)
  
  Cancelof
- Should be Empty:

201Q4 DISTRICT Convention 2026 EARLY BIRD Registration Form