2008 PENNSYLVANIA LIONS 85^TH STATE CONVENTION MD14

WASHINGTON , PENNSYLVANIA          MAY 15-18, 2008     

Hosted by District 14-M

REGISTRANT :

______________________________

________________________

________

_______

Last

First

Initial

DISTEICT

ADDRESS

______________________________

___________________________

______

______

Street Number/PO Box

City

State

Zip Code

_______________________

_______________________

_________________________________

Home phone

Business or Cell phone

Email address

LION___

LIONESS___

LEO___

NON-LION____

CLUB__________________________________  

HIGHEST OFFICE HELD ______________________

Past____

Present_____

Elect______

Other Office/Title_____________________________

SPECIALNEEDS_____________________________________________

SPOUSE/GUEST :

______________________________

________________________

________

Last

First

Initial

_______________________

_______________________

_________________________________

Home phone

Business or Cell phone

Email address

LION___

LIONESS___

LEO___

NON-LION____

CLUB__________________________________  

HIGHEST OFFICE HELD ______________________

Past____

Present_____

Elect______

Other Office/Title_____________________________

SPECIALNEEDS____________________________________________

Names of Children attending (Non-Leo):  ___________________     ____________________

Age ____

Names of Children attending (Non-Leo):  ___________________     ____________________

Age ____

HOTELS: Reservations must be made with this form.  Do not register directly with the Hotel.  Indicate your choice in order of preference.                     

THESE ITEMS MUST BE COMPLETED BEFORE ROOM REGISTRATIONS CAN BE FINALIZED

___ Holiday Inn (Host)                $ 77.00 plus tax

Arrival Date_____/______/_____

Arrival Time      ________PM

___ Hampton Inn (Adjacent)       $ 95.00 plus tax

Departure Date____/_____/_____

Departure Time ________AM

___ Comfort Inn (.7 mile)            $ 85.00 plus tax

No. of people in room _____

No. of beds _____

___ Springhill Suites (3.5 miles) $121.00 plus tax

Sharing room with _____________________________________________

___ Hampton Inn (3.8 miles)       $ 80.00 plus tax

SPECIAL ROOM REQUESTS.

___ Red Roof (7.5 miles)            $ 78.99 plus tax

Non Smoking ____

Handicap Accessible _____

___ Motel 6  (4.0 miles)              $ 40.33 plus tax

Other ____________________________________________

REGISTRATION FEES

Housing Deposit  …………………………………………………………...……

_____  X    $100.00 =           __________

Convention Registration ……(No fees for children under 12 or Leos)..……..…

_____  X    $ 12.50  =           __________

Ladies and Lioness Breakfast  (Friday) …………...…………………………….

_____ X     $ 11.00  =           __________

Model Lunch  (Friday) ……………………...…………………………………...

_____ X     $ 13.00  =           __________

Teen/Leo Pizza Party and Dance (Saturday)……………….…………………....

_____ X     No Charge

Key Member Breakfast  (Saturday)……………………………………………...

_____ X     $ 11.00  =           __________

International Banquet  (Saturday)………………………   ..Chicken Piccata

_____ X     $  24.00 =           __________

Stuffed Pork Chops

_____ X     $  24.00 =           __________

                                                                                                             Vegetarian

_____ X     $  24.00 =           __________

Melvin Jones Breakfast  (Sunday)  .………………………….…………………. 

_____ X    $  11.00  =           __________

District Governor’s Elect Honors Banquet  (Sunday)…….Boston Scrod

_____ X    $  24.00  =           __________

                                                                                                Roast Loin of Beef

_____ X    $  24.00  =           __________

                                                                                                             Vegetarian

_____ X    $  24.00  =           __________

Tour # 1 ( Trolley Museum and Quail Run Shops) …...……………..…………..

_____ X    $   15.00 =           __________

Tour # 2 (Westerwald Pottery and  Scenery Hill Shops) …....………….…….…

_____ X    $   15.00 =          __________

2008 Pennsylvania State Convention Pin ……………………….………………

_____ X    $     3.00 =          __________

TOTAL AMOUNT INCLUDING ROOM DEPOSIT ………………....……

                  $                         __________

MAKE CHECKS PAYABLE TO:  DISTRICT 14-M 2008 CONVENTION

MAIL TO:  PDG ED GURSKY,  129 BOYD AVENUE , BROWNSVILLE , PA 15417

DEADLINE FOR REGISTRATION IS APRIL 19, 2008   *  NO REFUNDS AFTER MAY 5, 2008