Circle K District Convention Individual Registration

School Name (if Kiwanis Committee, Circle K Alumni, or Advisor select KIWANIS)(Required)

Name(Required)

First Last Preferred Name

Pronouns

Position(Required)

Cell Phone(Required)

Email(Required)

T-Shirt Size(Required)

Do you have any dietary restrictions?(Required)

If yes, please provide details:

Registration Type(Required)

Total

Payment(Required)

If check, please submit to the District Office. Registration will be cancelled if check is not received by March 14, 2023 at 5:00pm.

Credit Card

Card Details

Cardholder Name

CAPTCHA

Kids Need Kiwanis