Clone of 201Q4 Convention 2026 Registration Form

PRE-REGISTRATION

(Note this will secure your spot, your full registration will be sent to you from March 2027)

27th 201Q4 DISTRICT CONVENTION 2027

Hosted by the Lions Club of Blackbutt Benarkin for

District Governor John Campbell

Where: Kingaroy Town Hall, 43 Glendon Street,

Kingaroy, QLD, 4610

When: Friday 22nd to Sunday 24th October 2027

Note - fields marked with * require an entry to be made
District
eg 201Q4.
Club Name
e.g. Marlborough & District
Club Number
eg 12345
Title
Primary Person Full Name

First NameLast Name
First Convention
Primary Person Mobile Number
Please enter a valid Mobile Number.Format: 0000 000 000.
Primary Person E-mail
example@example.com
- Title2
- Person 2 Full Name
  
  First Name2Last Name2
- First Convention2
- Mobile Number2
  Please enter a valid Mobile Number.Format: 0000 000 000.
- Title3
- Person 3 Full Name
  
  First Name3Last Name3
- First Convention3
- Mobile Number3
  Please enter a valid Mobile Number.Format: 0000 000 000.
- Pre-Registration deposit $30 per person ensures you secure your spot for the convention.
- Amount to be Paid
- Need Help? - Contact Convention Secretary
  
  Kathy McCosker Mob 0400 788 610
  
  or email convention.q4@lions.org.au
  
  EFT Payments to:
  
  Lions Club of Blackbutt Benarkin Convention 2027
  
  BSB 633 000 Account no 198 761 207
  
  Reference = Full Name of Primary Contact
- Date Submitted
  
  DayMonthYear
  2 digit day, 2 digit month, 4 digit yearDate
  Hour MinutesAM/PM Option
- Upload Your Payment Confirmation here (Optional)
  
  Cancelof
- Date Paid
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Deposit
- Email Sender
- Accommodation Options
  
  Room Motels Kingaroy - 76 Yougman St Kingaroy Map Here
  
  55 rooms all booked out for Lions (approx $160 per night)
  
  Call (07) 4162 5115 to book (Quote Booking Ref 411949)
  
  550M - 7 mins walk to the Town Hall.
  
  Room Motels Kingaroy East - 100 Kingaroy St Kingaroy Map Here
  
  45 rooms all booked out for Lions (approx $160 per night)
  
  (07) 4162 5115 to book (Quote Booking Ref 410044)
  
  550M - 7 mins walk to the Town Hall.
  
  Note - Room Motels, make sure you let them know you are Lions to get discounted rates.
  
  Kingaroy Holiday Park 48 Walter Road (D'Aguilar Hwy) Map Here
  
  Various cabins and van sites (07) 4162 1808 to book (Note - bookings can be made after 1st April 2027)
  
  1.3km 4min drive to the Town Hall.
- Should be Empty: