Midwestern Ontario District Optimist
Believe in K.I.D.S.
Convention Registration 
19th Annual Midwestern Ontario District Convention
Wheels Inn, Chatham, Ontario Aug 26,27,28, 2005


Complete the following to Register :

Ribbons (check all that apply) Cost
Member Surname: 
First Name: 
 Phone: 
 E-Mail: 
Club Name:
 Zone: 

First Timer
President
Pres Elect
Secretary
Treasurer
OIF Club Rep
Life member
Lt Gov
Lt Gov Elect
Past Gov
Past OI VP

$20.00

Member Surname: 
First Name: 
 Phone: 
 E-Mail: 
 Club Name: 
 Zone: 
First Timer
President
Pres Elect
Secretary
Treasurer
OIF Club Rep
Life member
Lt Gov
Lt Gov Elect
Past Gov
Past OI VP

$20.00

Spouse/Guest Name:  


$12.00

Children:

Name

Age

T-Shirt Size

T-Shirts must be worn for all youth activities
$6.00/child




Tickets


Qty

Opening Ceremoniess 

(Friday 8:00pm)

NC

Old Timers Breakfast 

(Saturday 6:59am)

$13.00ea

President 05-06 Luncheon 

(Saturday Noon)

$15.00ea

"Believe in Kids" Dinner and Entertainment

(Sat. 6pm)

$25.00ea

Sunday  Luncheon 

(Sunday 11am)

$20.00ea

Partner's Activity Day


$25.00

Youth Activities - Ages 5 to 17

Fri 7pm & Sat 7am   

$25.00ea
Registration should be received before July 15, 2005
Registration is payable by cheque and should be made out to  MIDWESTERN ONTARIO  DISTRICT

 

Hotel Reservation:
Wheels Inn, Chatham

Check if you require a room reservation    $98  -- plus taxes. 2 Double Beds

Room Occupancy:     Adults     Children

     ARRIVAL DATE:     TIME
DEPARTURE DATE  

Cot Required
Wheel Chair Access
Smoking
Non-Smoking
Since this is not a secure site,  you will be asked to submit your Credit Card information to reserve your room when you mail in your cheque for your registration fees. 
All Rooms must be booked through the Convention Registrar, Theresa Holden (theresa_h[at]sympatico.ca) to receive this room rate.

All unbooked rooms must be released by July 15, 2005

ATTENTION
Stay one extra night for the same price.
Stay either Thursday or Sunday.