NCCW 2017 Convention

Catholic Women: Living the Joy of the Gospel

September 6-9, 2017 Hilton Anatole, Dallas, Texas

THERE WILL BE NO ON SITE REGISTRATION LAST DATE TO REGISTER IS AUG15, 2017

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First Name Last Name

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Address City State Zip Code

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E-Mail Daytime or Cell Phone Number

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Emergency Contact Name Emergency Contact Phone Number

Do you have any physical, visual, or hearing needs with which NCCW can assist? □ Yes □No

If yes, please describe: ______

Is this your first NCCW Annual Convention? □ Yes □No

Will you attend the First Timers Orientation □Yes □ No

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Preferred Name for badge If registering spouse for Convention, name of spouse

AFFILIATION:

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Parish or Subdivision Affiliation Arch/Diocese

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Other: Guest, Speaker, etc. Please Specify

VOTING DESIGNATION: (Select one):

□ Individual □ Parish □ Deanery/District □ Diocese □ Non-Voting (Non-Member or Spiritual Advisor)

CONVENTION RIBBON CATEGORIES: Please select those that apply to you:

Current A/Diocesan President______Legacy Circle Member______

Individual Member ______100th Birthday Club Member ______

Supporting Member ______

REGISTRATION FEES: Please circle your selected fees

Registration Category / Full Convention
(Good thru June 30) / Full Convention
(July 1 – August 15) / OPTIONAL EVENTS / INVITATION ONLY EVENTS
Full rate
includes breakfast with speaker on Friday 9/8 / Full rate includes breakfast with speaker on Friday 9/8 / Sept 5 Tour of Dallas 1-4PM / Sept 6
Tour of Fort Worth
9am-2pm / Fundraiser
Sister’s Christmas Catechism / Province Dinner * / Saturday Night Closing Banquet / Spiritual Advisor Luncheon**
Only Spiritual Advisors May Attend / Leadership Luncheon ***
By Invitation Only
Current NCCW Board
Past NCCW Presidents
Current Commissions
Current Committees
Current LTD Team
Full Convention Registration / $300 / $350 / $45 / $50 / $30 / $70 / $80 / $46 / $45
One Day Registration
Date attending:
______/ $130 / $150 / $45 / $50 / $30 / $70 / $80 / $46 / $45
Spouse of Registrant / $150 / $150 / $45 / $50 / $30 / $70 / $80 / N/A / N/A

TOTAL PAYMENT DUE (from above): $__550.00__ (Includes Province Dinner* and Closing Banquet)

($450 Registration and Meals----$100 Seat on the bus)

Forms received without payment will not be processed

Please pay by check

Enclose check (payable to Theresa Pavlik) Check Number ______

Mail completedRegistration form and Payment to: Theresa Pavlik

PO Box 329

Verdigre NE 68783

Questions? Call Theresa (402-358-0608)

Cancellation Policy: There are no refunds but registration can be transferred

MEAL SELECTIONS

Please select one of the following choices for the Province Dinner by circling the letter:

A. Seared chicken breast with roasted shallot chicken jus, Buttered Basmati Rice, Snap Peas and Roasted Peppers or

B. Roasted Cod, Lemon Butter Buerre, Stack Buttered Basmati Rice, Snap Peas and Roasted Peppers or

C. Vegetarian Choice: Grilled Portabella, Tomato Pomodoro, Stack Buttered Basmati Rice, Snap Peas and Roasted Peppers

All meals come with a starter of Iceberg wedge salad with diced tomatoes, diced cucumbers, candied walnuts, and bleu cheese crumbles with duo tomato vinaigrette and bleu cheese, dinner rolls and butter, Water/ Iced Tea, Coffee and Tea and Banana cream tart, chocolate chards, strawberry coulis for dessert.