Florida District Convention Registration Form

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FLORIDA DISTRICT ANNUAL CONVENTION SEPTEMBER 14—15, 2012 AGENDA Friday, September 14 3:00 p.m. 7:00 p.m. Saturday, September 15 7:15—9:00 a.m. 7:30 a.m. 7:30 a.m. 9:00 a.m. 10:30 a.m. 10:45 a.m. Noon 1:00—2:30 p.m. 3:00 p.m. 6:30 p.m. 7:15 p.m.

District Board Meeting Dessert Social/Trivia/Entertainment Registration/Continental Breakfast Council of Past Governors President/President-Elect Forum General Business Session BREAK General Business Session Lunch with Speaker Awards and Celebrations 2012-2013 District Board Meeting Social/Cash Bar Dinner and Installation Banquet (After Five Attire)

________________________________________________________________________________________ HOTEL: Wyndham Orlando Resort, 8001 International Drive, Orlando, Florida Tel: 407 351-2420; 1-866-599-6674; www:wyndhamorlandoresort.com Rate:

$79 plus tax. TO RECEIVE THIS RATE, RESERVE BY AUGUST 14, 2012 Ask for Civitan Annual Convention rate

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REGISTRATION FORM Registration $95 if received no later than August 30, 2012 ; After that $110 ________________________________________________________________________________________________ Member Name: ________________________________________________________________________________________________ Spouse/Guest: ________________________________________________________________________________________________ Street Address: ________________________________________________________________________________________________ City/State/ZIP ________________________________________________________________________________________________ Current Club/District Office Held: ________________________________________________________________________________________________ Have you attended a Florida District Meeting/Convention before? Y _____ N _____ E-mail address: ________________________________________________________________________________ Any dietary or other special needs? ________________________________________________________________________________________________ Registration: $95 per person X ____ = $ _________ After August 30, $110 X _____ = $ ______ Make checks payable to : Mail registration form and fees to:

FLORIDA DISTRICT CIVITAN Gloria Poore, Registrar, 5353 Arlington Expy, No. 5A Jacksonville, FL 32211; Tel: 904 993-0111 E-mail: gandrpoore@yahoo.com


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