InterPACK Group Registration

School Name(Required)

Attendees Information

Name	Pronouns	Position	Cell Phone	Email	Do you have any dietary restrictions?	If Yes, please indicate	Registration Type	Actions

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Total Registered

Product Name

Price: $0.00

Total

Payment(Required)

If paying with a check, please make the check payable to PA Circle K and mail it to: PA District Kiwanis International, P.O. Box 62, Dillsburg, PA 17019. Registration will be cancelled and you will be billed for 50% of the cost, if your check is not received by October 9, 2026 at 5:00 PM.

Primary Contact Full Name(Required)

This person is responsible for payment for the group.

Primary Contact Email(Required)

This is the email that will receive payment receipt.

Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Kids Need Kiwanis

InterPACK Group Registration

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