REGISTRATION FORM

ODCCW 48th ANNUAL CONVENTION –April 23-25, 2016

Please print or type the following:

Name: Phone ( )

FirstLast

Address:

StreetCityZip

Email Address: First Name for Badge:

Affiliation: Deanery:

First time attendee? ___Yes ___NoWill you attend the First Time Attendee Orientation? ___Yes ___No

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_____ I have MEDICAL dietary restrictions. (Please attach restrictions in writing, including your name, affiliation and deanery, to the registration form. Arrangements must be made in advance. There will be no substitutions at Convention.)

_____ I am a vegetarian.

PLEASE CHECK ONLY ONE BOX:

NOTE: If you are a designated representative for an affiliation voting delegate who cannot attend, please send a letter from your affiliation president, stating whose vote you are carrying, to Kathy Kirchon at 2521McGregor Street, Lakeland FL 33815. Diocesan Board votes are not transferrable.

Voting Delegates:(please choose your highest voting position) Non-Voting Attendees:

Affiliation President / Member at Large
Affiliation Deanery Board Member / Clergy
Diocesan Board Member (vote not transferrable) / Religious
Guest

Please check allthe events and functions you plan to attend:

One-Day Registration / $25.00* / Sunday Lunch / $38.00
Please state which day - / per day / Monday Lunch / $30.00
Full Time Registration / $45.00* / Monday Banquet / $52.00
Full Package / $165.00

Please indicate your Monday Banquet meal preference: _____ Steak _____ Chicken

DEADLINES: Convention Registration –April 1, 2016 Banquet Reservation –April 1, 2016

*Late Registration Fee (after April 1,2016) is $15.00. No Exceptions will be made.

Absolutely no registrations/reservations accepted after April 15, 2016.

Amount Enclosed: Total Package $______

OR

Registration $______

Meals $______

Total $______

YOUR ROOM RESERVATIONS MUST BE MADE WITH EMBASSY SUITES:

407-597-4000 and reference group block ‘DCC’, by 3/25/16 to get the Convention rate

For registration use only: Date Received: Amount: Check #: