February 04, 2012      

District 16 Fall Conference
Registration
November 5-6, 2010

Register before Sept. 25, 2010 for discount.

100 - Lunches Ordered in Contract --- 99 Lunches Sold ---- 1 - Available
102 - Dinners Ordered in Contract --- 101 Dinners Sold ---- 1 - Available

Register each person separately.

First Timer (check means Yes)
Non-Toastmaster (check means Yes)
Program Presenter (check means you are an education or keynote speaker for this conference)

First Name (Required)
Last Name (Required)

Check Your Current Education and Leadership Accomplishment

CTM

CC

ATMB

ACB

ATMS

ACS

ATMG

ACG

CL

ALB

ALS
         

DTM
             
District Leadership Position (Current)

Division
T Gov

Division
O Gov

Division
K Gov

Area
Gov
       

District
Governor

Lt. Gov.
Education
& Training

Lt. Gov.
Marketing

District Title (other than those checked)
Past Leadership Position

Past
District
Governor

Past
International
Director
 


SELECT Club Name (Required) Use "Guest" if not a member of District 16.

Division (Required)
Area (Required T1, O1, K1 no dash)

Address
City
State
Zip

Email
(DO NOT PUT ANYTHING ELSE in the EMAIL BOX)

Phone (Required) (H)
format 999-999-9999
Phone (W)
format 999-999-9999
FAX
format 999-999-9999

Full Registration (pick your Saturday lunch AND banquet menu below)
All events during the conference - Friday night fun, Saturday continental breakfast, awards luncheon, educational sessions, evening speech contest and banquet.

Today is February 04, 2012
Early Full Registration by Sept. 25, 2010 -
$75.00
Full Registration after Sept. 25, 2010 but before Oct. 23, 2010 - $85.00

First Timer Full Registration (pick your Saturday lunch AND banquet menu below)
Includes all events and meals as listed for full registration above. Early Full Registration by Sept. 25, 2010 - $65.00
Full Registration after Sept. 25, 2010 but before Oct. 23, 2010 - $75.00
Late Registration (pick your Saturday lunch AND banquet menu below)
Full Registration for anyone who misses the Oct. 23, 2010. Full Registration after Oct. 23, 2010 - $100.00
A la Carte Registration (attend what you want when you can)

Friday Evening Fun Night - $0.00
Saturday Business - Free

Education Sessions (No meal) - $0.00
Saturday Awards Luncheon (pick your lunch meal below) - $45.00
Saturday Evening Banquet and Contest (pick your banquet meal below) - $55.00
Gallery Seating for Saturday Speech Contest - $10.00

Saturday Awards Luncheon Menu

If are registering for the entire event (Full Register) or if you are registering A La Carte for the Saturday Awards Luncheon, pick your choice of main course.

Vegetarian Turkey Club Beef Croissant

Saturday Awards Banquet Menu

If are registering for the entire event (Full Register) or if you are registering A La Carte for the Saturday Banquet and Contest, pick your choice of main course.

Blackened Pork Loin Mushroom Stuffed Chicken Vegetarian

$
Submit registration and mail this amount to:

Benjamin Cox, ACG, ALB
benjamin@benjcox.com
1721 Marietta
Pryor, OK 74361
(918) 825-5014

benjamin@benjcox.com
709