Regional Meeting Registration Form

Thank you for registering to attend the

2019 Midwest-Western Region Continental Societies, Inc

“Regional Meeting”

Renaissance St. Louis Airport Hotel

 9801 Natural Bridge Road | St. Louis Missouri  63134

Phone: 1-314-429-1100

(See Map)

Registration Deadline: March 20, 2019 (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 25, 2019

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


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

Payment button for PayPal will show after submitting your registration information