ALPHA DELTA KAPPA DECEMBER 2010 - Gedung Kuning

6. CoNVeNtioN reGistrAtioN
pre-registration policy: To be considered pre-registered, your registration must be received by Friday, June 17. After this date, all registrations
and changes must be processed at the Convention Registration Desk during the Convention.
total
A. member (Includes EDUCATIONAL SYMPOSIUM, Name Badge, Convention Registration Packet, Business Sessions,
Speakers, Regional Luncheon and Reception, Banquet and Favor.)
received at headquarters by may 1 $200
received at headquarters may 2-June 17 $225
received at headquarters after June 17 or on-site $250
B. one-day educational symposium oNly (Not AtteNdiNG CoNVeNtioN)— Wednesday, July 13
Professional Growth/Fraternity Education Breakout Session Choices
Presenters:
Please do
not register
for your own
session.
received at headquarters by may 1 $100
received at headquarters may 2-June 17 $125
received at headquarters after June 17 or on-site $150
refer to session titles printed on pages 10-13 or on the 2011 international Convention section of the international Website.
Write in session numbers, indicating your first, second and third choices for each July 13 time slot.
July 13: 10:00-10:50 Am: first Choice # second Choice # third Choice #
July 13: 11:00-11:50 Am: first Choice # second Choice # third Choice #
July 13: 1:45-2:35 pm: first Choice # second Choice # third Choice #
C. optional special event fees:
past s/p/N presidents’ & little Wigs’ (Past International Chapter Members) luncheon $30 each
evening of entertainment $20 each
memBer BANQuet eNtrée: qchicken qvegetarian
d. NoNmemBer Guest tiCkets
Please specify how many tickets you are purchasing for each event.
Banquet Guest (Not included in ADKA registration fee) entrée: qchicken qvegetarian $70 each
regional luncheon Guest $35 each
e. ADkA (Association for men) Convention registration $25 each
Name to appear on badge
(Includes Annual Dues, Social Hours, International Chapter Reception, General Session
Speakers, name badge and program. Does not include Banquet. Tickets may be
purchased above for the Banquet and/or the Regional Luncheon.)
ADkA membership dues for ADkA members Not AtteNdiNG CoNVeNtioN $20
ADkA member name
f. 2011 international Convention charm, quantity: ; pin, quantity: $5 each
G. 2011 international Convention proceedings $5 each
h. 2011 international Convention dVd $10 each
i. ADk Badge holder/Neck Wallet $5 each
totAl fee eNClosed: (Add registration(s), special functions, guests’ tickets and pin/charm) $
Registration and ticket fees must be paid in U.S. Funds only. Make checks payable to Alpha Delta Kappa.
CANCELLATION POLICY: Cancellations must be received in writing by June 17, 2011 to qualify for a refund.
7. Credit CArd pAymeNt
MasterCard/Visa only Amount $
Name (as it appears on your card)
Auth.#: ref.#:
PLEASE MAKE SURE YOU INCLUDE THE COMPLETE CREDIT CARD NUMBER.
Card No. Exp. Date SIGNATURE
REMINDER: Materials for registrations received after June 17 will be available at the Convention
registration desk. When you register by June 17, 2011, your Convention name badge, ribbons and
tickets will be mailed in June. A $10 processing fee will be charged for replacing lost or forgotten name
badges and tickets. Pre-purchased Convention pins, charms and ADK badge holder/neck wallets will
be distributed at the Convention.
16
Copy this form to keep for your reCords.
Excellence in Action in Leadership
office use only: BAtCh#: