Step1: Please fill out the form below and E-mail it to Amy Brown at ambr@live.unc.

edu Step2: Send a check payable to CAROLINAS DISTRICT CIRCLE K Step3: Mail payments to the address provided ***Only 1 form per club***
Club Name Person completing form Contact phone #
($ 90 )
l-Y o Lu u-C nc an h ($ -Eat 11 .5 0)

Send all payments to be received by September 22nd to:

M /F
Un Dr limi i n te ks d ($ 6. 50 )

Amy Brown 108 Shadowood Dr Apt. F Chapel Hill, NC 27514

Al Gu e st
2013-2014 Club Officer?
(please specify)

ria n?

CK I

er

Op tio ($ n B 51 .5 0) Op tio ($ n C 38 .5 0)

tio n

an ia

registered)

Gr a

(confirmation email will be First nameLast name sent to each individual (as it will appear on name tag)

Ad vi so

de r:

ta

sI

Op tio n

Ci rc le

du a

Ve ge

Ki w

Ge n

Ci rc le

Al

Ye ar

um

ATTENDEE

EMAIL

Yr

1 2 3 4 5 6 7 8 9 10 11 12

Example - Amy Brown

ambr@live.unc.edu

2015

Historian/Bulletin Editor

Sub-Totals (Attendees*Registration)

Option A:

$90.00

Option B:

$0.00

Option C:

$0.00

Drinks

$6.50

Lunch

$11.50

Total Due

$108.00

Late fee ($20 per attendee if postmarked after September 22nd)

Indicate any special needs for attendees (e.g. lactose intolerant, nut allergy, etc):
All attendees will be required to sign a code of conduct and fill out a medical form upon arrival.