2017 New England District Fall Conference

Who is invited? New England Circle K members, prospective members, and guests above the age of 18 are invited for the weekend               

What is happening? A fun-filled leadership weekend with team building, fellowship, and service activities all focused on the Courage to Engage

When is it? November 10th-12th 2017! (Registration begins at 6:00pm on Friday November 10th)

Where is it? Camp Cedar Hill (265 Beaver St, Waltham, MA 02452)

Why go? Meet Circle K’ers from all over New England, while learning what it means to step out of your comfort zone and be an engaged citizen and to have fun!

How much is it? The cost of the event is $50, which includes lodging, conference materials, and 4 meals (3 on Saturday and breakfast Sunday). By paying online you are subject to a 2.9% + 30¢ charge ($1.75). 

Registration Deadline: All forms and payments must be received prior to Friday October 27th.

Please mail your check or money order to:

Frank Dennett

272 Rollingwood Rd

Eliot ME 03903

Please make your checks out to: New England Circle K.

Disclaimer: Payment must be submitted prior to the event. Payment will not be accepted after the event.  Refunds will only be grant for serious illness or extreme circumstances.

What to bring: toiletries, sleeping bag, blanket, pillow, work clothes, a flashlight, and an open mind.

Please forward any specific questions, comments, concerns, or special acommendation requests to Governor Daniel @ dnorwood.cki@gmail.com

Payment

Registration Form

Name *
Name
no spaces or symbols
If none, write NA
If none, write NA
Which do you associate most closely with:
CKI Questionnaire *
CKI Questionnaire
I am attending Fall Conference because of Service
I am attending Fall Conference to develop my leadership skills
I am attending Fall Conference to meet new people
I am attending Fall Conference to learn more about myself

Medical Questionnaire and Emergency Medical Treatment Authorization Form

*Please type or print this form. This form is required for all participants attending Fall Conference and must be completed in full. 

Name *
Name
No Spaces or Symbols
Name, Relation, and Number
Doctor Information:
Name of Doctor
Name of Doctor
Address
Address
Please answer “Yes” or “No”:
If none, please put NA
Please provide additional detail if YES
Please read carefully: I hereby certify that the information given above is correct. In case of medical emergency, I understand that every effort will be made to contact the person designated above. In the event that person cannot be reached, or time does not permit, I hereby give permission to a licensed physician to provide proper treatment for,
Signature_________, Date____________