This document is a registration form for the 2016 Alpha Delta Kappa Gulf Region Conference to be held from June 29th to July 1st at the Jackson Marriott in Jackson, Mississippi. The form requests contact information, registration details including meal selections and additional event tickets, workshop selections, payment information, and hotel reservation details. Special events include a leadership luncheon and past presidents' breakfast.
This document is a registration form for the 2016 Alpha Delta Kappa Gulf Region Conference to be held from June 29th to July 1st at the Jackson Marriott in Jackson, Mississippi. The form requests contact information, registration details including meal selections and additional event tickets, workshop selections, payment information, and hotel reservation details. Special events include a leadership luncheon and past presidents' breakfast.
This document is a registration form for the 2016 Alpha Delta Kappa Gulf Region Conference to be held from June 29th to July 1st at the Jackson Marriott in Jackson, Mississippi. The form requests contact information, registration details including meal selections and additional event tickets, workshop selections, payment information, and hotel reservation details. Special events include a leadership luncheon and past presidents' breakfast.
Alpha Delta Kappa Gulf Region Conference June 29-July 1, 2016
Jackson Marriott, 200 E. Amite St., Jackson, MS. 39201 “Making Connections….Cultivating Success”
Name Last, First_____________________________________ Name on Badge___________________ Address (Street, City, State, Zip)__________________________________________________________ Home Phone#___________________________________Cell Phone #____________________________ Emergency Contact Name_____________________________Emergency Phone #_________________ Chapter (State and Name)________________________________Current Office___________________ Email Address:________________________________________________________________________________ Food Allergies:_________________________________Banquet Choice: ___Salmon or ___Pork Loin Member Registration includes Registration Packet, General Sessions, Workshop, Reception, Luncheon, Evening of Entertainment, Banquet, Favors, and “Swag Bag.” _____Full Registration Received by May 25, 2016 $130.00 $__________________ _____Late Registration Received by May 26 – June 17, 2016 $150.00 $__________________ _____On-site Registration $180.00 $_________________ Special Events _____S/N Leadership/Membership Luncheon $ 28.00 $__________________ (S/N Membership Team, IC members & Little Wigs invited) _____Past State/National Presidents’ Breakfast $ 25.00 $___________________ (I was State/National President of _____ during the ______ biennium.) Guest Tickets and Regioneer & Gulf Region Pin Order _____ Reception: name of guest(s)_____________________(#___) $ 20.00_____________________ _____ Luncheon: name of guest(s)_____________________(#___) $ 35.00_____________________ _____ Banquet: name of guest(s)______________________(#___) $ 50.00 ____________________ Gulf Region Pin (optional) $ 5.00 ____________________ th Regioneer Pin (optional, if this is your 5 conference) $ 5.00 ____________________ (Check all that apply) TOTAL $__________________________ ___S/N Officer _____________________________ District Chairman______________________________ ___Past Regional International Vice President (Region and Date)__________________________________ ___Past International Chapter (Dates)_______________________________________________________ ___Chapter Officer (2016-2018)____________________________________________________________ ___Golden Sister (50 years) ___Sapphire Sister (35 years) ___Silver Sister (25 years) ___First Timer to a Gulf Conference ___Regioneer (has attended five (5) or more conferences ___Gulf Chorus Volunteer __ Instrument Ensemble Volunteer (Practice on Tuesday, June 28, 8:15 p.m.) ___Assistant Sergeant-at-Arms (meeting Tuesday, June 28, 4:15) WORKSHOPS – List the number of your chosen workshop session beside the letter. Workshop descriptions are available in this packet and on the Gulf Region section of the International website. A_____B_____C_____D_____E_____F_____ G_____ Make checks payable to: ΑΔΚ GRC; Mail to: Gretchen Waters, 126 Chandler Rd., Purvis, MS., 39475- 4154; Cancellation Policy: Requests for refund must be in writing by June 17, 2016. Hotel Reservations: Book your group rate for Alpha Delta Kappa Regional Conference Gulf Region Cost of the room is $129 (+tax) + $6.oo parking per night. Check in is: 3:00 p.m.