Michigan District of Key Club

Fall Rally

Fall Rally Registration

Your registration has not processed if you do not see the "Thank You" page. If you do not receive a confirmation email once registration is submitted please contact Jordan De La Cruz.

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Participant Name*

First Last

Participant Phone*

Participant Email*

Participant Type*

Student

Adult

Adult Role(s)

Faculty Advisor

Kiwanis Advisor

Parent

Kiwanian

Circle K

Other

Key Club of ...

Kiwanis Club of ...

Circle K of ...

Club officer?

Yes

Officer Role

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Officer Role

Division*

Shirt Size*

Grade

Do you have any allergies or dietary restrictions?*

Dietary Restrictions

Chaperone Name*

First Last

Registration Fee

Registration includes lunch and T-shirt. *Late registration is not guaranteed a T-shirt.*

Registration Fee Options*

Paying for my fee only with my registration

Paying for multiple participants with my registration

Registering only - payment will be with other registration

Registering only - mailing check

Registration Fee

Price:

Quantity

Discount Code

If you have been given a discount code, enter it here.

Total

Participants Paid

List all participant names, one per field. Add fields as needed.

Name of person paying registration

List only if different from yourself. (Advisor, School, etc.)

Check from...

List the person, school or organization that will be sending the check.

Credit Card

Cardholder Name

Card Details

Text