2018 Registration Form

Title

Name

First and Last Name

Club Name

District

First Lions Convention?

YesNo

Title

Name

First and Last Name

Club Name

District

First Lions Convention?

YesNo

Mailing Address

Street Address

Street Address Line 2

CityState

Zip Code

Phone Number

Include Area Code

E-mail Address

EARLY REGISTRATION DEADLINE IS APRIL 15, 2018

Late registration fee (after April 15th): $45.00 per person

No meals may be available for registrations received after April 30th!!

Lions members must be registered to vote, be a vendor, or attend any function of the convention.

Select each event you will attend and the total number of attendees. A la carte:

Early Registration Fee $25.00

Number of Attendees
Item subtotal:$0.00

Late Registration Fee (After April 15)$45.00

Number of Attendees
Item subtotal:$0.00

Friday Luncheon$25.00

Number of Attendees
Item subtotal:$0.00

Friday Night Dinner$37.00

Number of Attendees
Item subtotal:$0.00

Saturday Breakfast with the Eye Bank - Be sure you check if you want breakfast!!!$ Free

Number of Attendees
Item subtotal:$0.00

Saturday Luncheon$27.00

Number of Attendees
Item subtotal:$0.00

Saturday Dinner$37.00

Number of Attendees
Item subtotal:$0.00

OR Full Convention Book - Early Registration + All Meals Included$145.00

Number of Attendees

OR Full Convention Book - Late Registration + All Meals Included$165.00

Number of Attendees

Total $0.00

Dietary restrictions:

For more information, contact PDG Cathy Valenzuela at 719-560-0694 or LionCathyV@comcast.net

Make checks payable to: Lions State Convention Fund and mail with this form to: Lion Carol Louks - 4266 W. Pondview Drive, Littleton, Colorado, 80123

Or register online at http://www.colions.org and pay with PayPal or a Credit Card!