Fillable Midyear Planning Conference Registration Form 2016 (Optimist International)

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Midyear Planning Conference Registration Form 2016 (Optimist International)

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President’s Midyear Planning Conferences
Registration Form
☐ Winston-Salem, NC (February 3-4, 2017)
☐ St. Louis, MO (February 10-11, 2017)
(Please select location of Planning Conference attending)
REGISTRATION & PAYMENT METHOD (Choose one)
1) Register online via Credit Card
2) If paying in US funds, fax this form with credit card information to 314-735-4121 or
3) Mail this form, with check or money order payable to Optimist International, to:
Optimist International
President’s Midyear Planning Conferences
Cc: Payton Harris
4494 Lindell Blvd.
St. Louis, MO 63108
SPACE IS LIMITED, PLEASE REGISTER EARLY.
Pre-registration is required.
For any inquiry please call: Payton Harris at 800-500-8130 ext. 208
GENERAL INFORMATION
Registrant’s Full Name:
Member Number:
District / Club Officer:
Billing Address:
City, State/Province, Postal Code:
Phone:
Fax:
Email:
If you are registering and paying for more than one person, please list them here:
Name
Member Number
District / Club Officer
ORDER INFORMATION
Cost per person:
$25 USD
(or its equivalent in $CND – depending on the currency exchange for the quarter)
Total Authorization Amount:
$
Credit Card Type:
Credit Card #:
CVV#
Expiration Date:
SIGNATURE:
Persons canceling registrations the Sunday before the chosen conference will receive a full refund of fees paid e.g. If
the conference is on Friday, February 3, the deadline would be 11:59pm, Sunday, January 29. Because we have to give a
guarantee to the caterer in a timely manner, persons canceling after the Sunday before the chosen conference will
receive no refund. NO SHOWS will not be refunded.
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Midyear Planning Conference Registration Form 2016 (Optimist International)

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Completed 23 July 2020

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