2009 Convention

June 25-28, 2009 –
Four Points by Sheraton
319 Fountains Pkwy, Fairview Heights, IL 62208 
(618) 622-9500
Convention Registration Form
Name _______________________Exchange Club _______________________
Address _____________________________Delegate, Club or District Office Held___________
City___________________, State___, Zip Code___________
Area Code and Phone Number______________
Nickname for Badge Spouse/Guest Name_______________________
E-mail address________________________

Full Convention Package
Friday Night Entertainment@ $115 each_____________
Saturday One Nation Under God Breakfast          After June 1, 2009 - $125 each
Saturday Installation Dinner_______Final Meal Reservations Due by June 16, 2009Sunday Youth of the Year/ACE Awards Brunch________
District Director/Officer @ $75

(Optional Events)
Thursday Old Fashioned BBQ & Ice Cream Social@ $22.95 each_________
BBQ & Ice Cream Social - Kids over 12@ $10 each ________
Friday Motivational Lunch@ $25 each __________

Individual Event Prices
Friday Night Entertainment@ $10 each__________
Saturday One Nation Under God Breakfast@ $35 each_________
Saturday Installation Dinner@ $45 each________
Sunday Youth of the Year/ACE Awards Brunch@ $35 each______
Total Enclosed _______

Please register before June 1, 2009
Mail completed form and payment to:
Paul Zollner
Exchange Club of Belleville
404 Sycamore, Belleville IL 62220
Make checks payable to: District Convention 2009