Capital Key Club District Leadership Conference 2023

Please use this form to register for the Capital District Leadership Conference taking place from March 24-26, 2023 at the Hyatt Regency Crystal City. Any questions regarding the registration form or registration changes, please contact Kristina Dlugozima at kmsd512@gmail.com. Registration is due by March 5th. Registrations received after March 5th cannot be guaranteed room shares and will incur a late fee.

Key Club Name *

Division *

List all chaperones and their e-mail addresses to facilitate background checks. Please also indicate if they are a member of Kiwanis. Background checks are only required every two years so if you received one last year, you will not need another one this year. All chaperones are required to have a background check from Kiwanis' vendor even if you are a school employee or already background checked. The cost of the background check will be covered by your registration fee - no additional charges apply. *

Contact Person *

Is this an adult or a student? *

Adult

Student

Address *

City/Town *

State/District *

Zip Code *

E-mail Address *

Phone number *

Chaperone/Adult Registration - Please indicate the number of adults/chaperones requesting each type of room. The Capital District will do room shares for any advisor requesting a double room without a roommate. You must put a number in each box so put a '0' where needed. *

	Single Room (395.00)
	Double Room (255.00)

Student Registration - Please indicate the number of students registering for each room type. The Capital District will do room shares for any rooms that your school is not able to fill but would like a quad. Please do not choose triple if you need a room share as that will be difficult to match. You must put a number in each box so put a '0' where needed. *

	Double Room ($255.00)
	Triple Room ($210.00)
	Quad Room ($185.00) )

Upload your hotel list spreadsheet here. All student and chaperone names should be included in full. The spreadsheet can be found in the original registration e-mail as well as the Capital Key Club website. *

How many vegetarians do you have? *

How many members/advisors that are gluten free do you have? *

Any other dietary restrictions? *

Are any of your registrants observing Ramadan by fasting during the day?

How many of each t-shirt size?

	Quantity?
Small	Quantity?
Medium	Quantity?
Large	Quantity?
X-Large	Quantity?
XX-Large	Quantity?
XXX-Large	Quantity?

Any additional comments or things Capital District Key Club needs to know? Information about room shares or requests should go here.

Credentials Registration

Each club is allowed up to two delegates who will vote in Sunday morning's House of Delegates. Often these delegates are incoming club officers, but they can be whoever the club wishes to represent them.

Additionally, the club may choose two alternates who will serve as the club delegate if one of the delegates is unable to attend District Convention.

	Name
Delegate 1	Name
Delegate 2	Name
Alternate 1	Name
Alternate 2	Name