CONVENTION AND HOTEL RESERVATION FORM LIONS CLUBS 101ST INTERNATIONAL CONVENTION Lions Clubs International Convention 2018 Las Vegas, Nevada USA • Friday, June 29 – Tuesday, July 3, 2018 DEADLINES MAY 1, 2018: Deadline for advance registration and hotel reservation. Deadline to submit a refund request for registration, housing and/or ticketed event cancellation. REGISTRANT INFORMATION: Please type or print name as it appears on passport/photo ID. First Name/ Family (Last) Name Address City Daytime Phone Lion Lioness Alpha Leo Omega Leo State Postal Code E-mail Adult Guest Club No. Membership No. Badge/Call Name Omega Leo Adult Guest Club No. Membership No. Age District Title Alpha Leo District Title Country Badge/Call Name COMPANION: First Name/ Family (Last) Name Lion Lioness Alpha Leo CHILD: First Name/ Family (Last) Name PACKAGE A: Includes convention registration for each registrant listed above plus one (1) hotel room serviced by shuttle buses during convention. Before January 12, 2018 After January 12, 2018 Hotel Name Arrival Day/Date Departure Day/Date No. of Guests in Room ____ No. of Beds Needed 1 2 (a fee applies for a guaranteed bed type) Special Requirements: Wheelchair Accessible Other US$200 Hotel Deposit is per room and credited to your hotel bill at check out. All rooms are non-smoking. Reservation in delegation hotel I prefer my delegation hotel Prefer another hotel PACKAGE B: NO ROOM REQUIRED (Registration only for each person listed above.) OPTIONAL TICKETED EVENTS I/we plan to attend the following event(s): (Must be registered to attend) EVENT: MELVIN JONES FELLOW LUNCHEON DATE/TIME FEE QUANTITY July 2/ 13:00-14:30 US $75 ______ AMOUNT DUE $ _______ EVENT: DISTRICT GOVERNOR/PAST DISTRICT GOVERNOR BANQUET DATE/TIME FEE QUANTITY AMOUNT DUE July 2/ 20:00-22:00 US $135 ______ $ _______ SERVICE PROJECTS IN LAS VEGAS I am interested in participating in a hands-on community service project during the Las Vegas International Convention. Further details on registering for service projects will be sent to you in the coming months. PAYMENT: Full payment is required with this form. US currency only. Checks and money orders must be drawn on US banks. Visa, MasterCard & Discover cards accepted. REGISTRATION FEES: Adult Child (17 and under)/Alpha Leo Omega Leo PACKAGE A: PACKAGE B: EARLY (Before January 12, 2018) US$150 US$20 US$100 Registrations: US$ _________ Registrations: US$ __________ REGULAR (January 13 through March 31, 2018) US$200 US$20 US$100 Ticketed Events: US$ _________ Ticketed Events: US$ __________ 200.00 LATE (April 1, 2018 – onsite) US$225 US$20 US$100 Hotel Deposit: US$ _________ Total Due: US$ _________ Total Due: US$ __________ Check # ______ Wire transfer (payment slip must be attached to this form) Visa MasterCard Discover Name as it appears on card Credit card must be in the name of the registrant. ___-___-___-___-___-___-___-___-___-___-___-___-___-___-___-___ Card Number X ___-___-___-___ Expires Month/Year ___-___-___ Security code (3 digits) Cardholder Signature Mail form and payment to: Lions Clubs International Attn: Convention Division • 300 West 22nd Street Oak Brook, IL 60523-8842 USA • Allow 4 weeks for processing. • Credit Card and Wire Transfer Payments can be faxed to: (630) 571-1689 • LCI will email your Official Registration Confirmation. Please print and bring with you to Las Vegas. • NEW THIS YEAR! All registrants will pick up their name badge onsite in Las Vegas. Badge printing stations will be available at all LCI hotels. LCI will not mail badges in advance. • Questions? Email us: firstname.lastname@example.org. Please note: Lions Clubs International will be documenting the international convention for promotional purposes. Your participation may be filmed or photographed at this event. Your registration is your consent for use of these images by Lions Clubs International.