Regional Meeting Registration Form

Thank you for registering to attend the

2018 Midwest-Western Region Continental Societies, Inc

“Regional Meeting”

Crowne Plaza Dallas Near Galleria-Addison

 14315 Midway Rd | Addison, TX 75001

Phone: 1-877-270-1393

(See Map)

Registration Deadline: March 16, 2018 (Postmarked)

Complete online registration below or
download, print and mail-in registration form with your payment

Midwest-Western Regional Registration Fee: $85.00
Late Registration Fee: $110.00  Accepted Online Only Until March 30, 2018

ON-SITE REGISTRATION ($100) ACCEPTED WITH CASH, CASHIER’S CHECK or PAYPAL

First Name (required)

Last Name (required)

Your Email (required)

Street Address (required)

City (required)

State (required)

Zip Code (required)

Phone Number (required)

Chapter and Officer Information

Chapter Name (required)

Local Office Held

Regional Office Held

National Office Held

Meals

Regional Meeting Registration fees include the following meals:

- All schedule meetings, activities and lunch (Saturday)

- Regional Registration Breakfast w/ Hotel Room Registration

Hotel registration must be made separately by each attendee.

Select Your Dietary Needs (required)

Transportation Information

Arrival Date (required)

Arrival Time

Departure Date

Payment Information

Select Payment Option (required)

Mail to:
Continental Constance Seymore
Financial Secretary-Midwest-Western Region
Continental Societies, Inc.
925 Brook Knoll Lane
Cummings, Georgia 30041
708-415-2061

Payment button for PayPal will show after submitting your registration information

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