State Convention Pre-Registration Form for Lodge Members
Deadline for Pre-Registration July 31st, 2016------Late Forms accepted till August 12, 2016
This form is for the N C Moose Association90th Annual State Convention at the Sheraton Greensboro Hotel at Four Seasons, August 18/21, 2016.
Please type or print
Members Name______Title (If Any) ______
Gov, Past Gov, Adm. or Other Officer
Address ______City ______, NC Zip ______
Members E-mail Address______
Lodge Name ______Lodge Number ______
Notice to Members of the 5 Club or 25 Club
All members qualified for the 5 Club/25 Club dinner will be sent a pre-registration form to their home address and must use that form if they plan to attend. Since we must guarantee the number of meals to be served in advance, we will only have tickets available for members that have pre-registered and indicated on the form that they will attend, they must also indicate if they will bring their spouse or guest. Sorry but members that don’t pre-register on the form sent to all members who are qualified will not be allowed to attend the 5 Club/25 Club Dinner.
Are you a First Time Attendee? [___] Yes or [___] No
Payment must be sent with form to receive discount price. Pre-registration Price Late Registration Price
Event Good till July 31, 2016 Forms Received
(Number of Tickets)After August 1, 2016
Fellowship Breakfast, 8:00 AM Saturday, Aug 20th ______@$15.00 ea.______@$20.00 ea.
Must have meal ticket hold the Fellowship Degree or be a Candidate for the Degree to attend After August 1, 2016
Pilgrim Luncheon, Noon Saturday, Aug 20th______@$18.00 ea. ______@$25.00 ea.
Must have meal ticket and hold the Pilgrim Degree to attend After August 1, 2016
Banquet for President and Deputy Grand Regent______@$35.00 ea. ______@$45.00 ea.
6:00 PM Saturday, Aug 20thMust have meal ticket to attend Installation of Officers, doors After August 1, 2016
will not be opened for others to attend. You must have two (2) tickets if Spouse or Guest will attend.
Dance 8:00 PM Fri. Aug 19th, Saturday, Aug 20th______@$5.00 ea.______@$10.00 ea.
You will need two (2) tickets if Spouse or Guest will attendAfter August 1, 2016
One ticket will admit holder to both Friday and Saturday dances
Family Breakfast and Awards Ceremony______@$15.00 ea. ______@$20.00 ea.
8:00 AM Sunday, Aug 21stMen, Women & Children invited, each will need a ticket After August 1, 2016
Convention Registration Fee _____1___@$15.00 ea. ______@$25.00 ea.
Everyone must pay Registration Fee After August 1, 2016
Number of Non Member Guest Badge(s)______@$ 5.00 ea. ______@$10.00 ea.
Must register to attend Dance or Hospitality RoomAfter August 1, 2016
First and Last Name for Guest Badge(s) ______
Attach List for additional guest if more room is needed
TOTAL AMOUNT DUE$ ______$ ______
Amount till July 31, 2016After August 1, 2016
Please make checks payable to N. C. Moose Association and return form with payment prior to July 31, 2016 to receive the Pre-Registration Price. Forms received after August 1, 2016 will be charged the Late Registration Price and any amount due will have to be paid when you pick up your packet. Form must be mailed to:
Alvin Stroud Jr
Phone 828-669-0689Secretary NCMA
532 Blue Ridge Road
Forms received by Email will be charged onsite registration prices!Black Mountain, NC 28711
This form not for Chapter Members use,
formshavebeen sent to each Chapter .