InterPACK Individual Registration

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

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 make the check payable to PA Circle K and mail it to: PA District Kiwanis International, 125 North Enola Drive, Suite 206, Enola, PA 17025. Registration will be cancelled and you will be billed for 50% of the cost, if your check is not received by November 7, 2022 at 5:00 PM.

Credit Card

Card Details

Cardholder Name

CAPTCHA

Kids Need Kiwanis

InterPACK Registration 2022 - Individual

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