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

Enquiries to the secretary Kathy at convention.q4@lions.org.au

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 Number
Primary Person Mobile Number*
Please enter a valid Mobile Number.
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.
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

Person 2

Person 3
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?

YesNo
Need Help? - Contact Convention Secretary

Kathy Barrett ph. 0438 331 265

or email convention.q4@lions.org.au

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