2015 Midyear Conferences
Registration Form
One person per registration please

Registration Deadline Two Weeks Prior

February 28, 2015 Plaza Hotel & Suites, 1202 W Clairemont Ave, Eau Claire, WI 54701
$25.00 per person/$35.00 after Deadline (includes lunch)

March 7, 2015 St. Patrick's Parish School, 534 Sunset Dr, Elkhorn, WI 53121
$25:00 per person/$35.00 after Deadline (includes lunch)

March 21, 2015 Fox Valley Technical College, 1825 N. Bluemound Drive, Appleton, WI 54912
$20:00 per person/$30.00 after Deadline (includes lunch)

April 25, 2015 Deer Valley Lodge, 401 Industrial Dr, Barneveld, WI 53507
$35.00 per person/$45.00 after Deadline (includes lunch)


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Midyear Locations
Please choose the location of the Midyear you will be attending. You may choose more than one. If you choose more than one, you will need to pay the registration fee for each location chosen.
Session 1 February 28, 2015 Eau Claire - $25.00 per person/$35.00 after Deadline
The Lt Governor election for Division 9 will be at this location
Clear selection
Session 2 March 7, 2015 Elkhorn - $25.00 per person/$35.00 after Deadline
The Lt Governor election for Divisions 1 and 5 will be at this location
Clear selection
Session 3 March 21, 2015 Appleton - $20:00 per person/$30.00 after Deadline
The Lt Governor election for Divisions 7 and 11 will be at this location
Clear selection
Session 4 April 25, 2015 Barneveld - $35.00 per person/$45.00 after Deadline
The Lt Governor election for Division 3 will be at this location
Clear selection
Workshops
Please choose Club Leadership Education and or Workshop Track you would like to attend. You may choose more than one if you would like.
Club Leadership Education (for Club Presidents-elect)
Clear selection
Workshop Track 1 Service
Clear selection
Workshop Track 2 Club Leaders
Clear selection
Workshop Track 3 The Formula/Membership Development
Clear selection
Your Information
Member First Name *
Last Name *
Phone Number *
Email *
Enter none if you don't have one.
Division # *
Kiwanis Club Name *
2014-2015 Office Held
Payment Information
Please complete the information below to pay by credit card or call with your credit card information at 920-361-9954 or send a check made out to WI-UM Kiwanis District, to  571 Center St., Berlin, WI 54923
Total Amount Owed
Method of Payment *
CHARGE CARD AUTHORIZATION
Please feel free to call in your credit card number to 920-361-9954 if you do not want to submit it on the form.
Please Check:
Account Number
Card Exp Date
Name on Card
Zipcode
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