Send
Section 1 of 6
*(MAKE A COPY FIRST, DO NOT EDIT)* - District Convention 2022 Club Registration
Welcome! This is the District Convention 2022 Registration for *club name*

What is District Convention?
The California-Nevada-Hawaii District Circle K District hosts an annual three day and two night event called District Convention for clubs all around the district. DCON 2022 will be held from March 25th - 27th at the Westin Los Angeles Airport Hotel. Attendees get to learn more about all levels of Circle K International, network with professionals, and educate themselves on how to become aspiring leaders. District Convention is an event where attendees get together and celebrate all of the achievements of the district and acknowledging all club’s hard work. Our committee can't wait to welcome you to join us at this amazing wonderland 🌟

If you need assistance/guidance on completing this form, please contact myself, any E-Board members, or DCON 2022 Registration Chair, Janice Lee, with any questions/comments/concerns.

*Your Club Position | Name*
*email*

District Convention 2022 Registration Chair | Janice Lee
cki.dcon.register@gmail.com
Question Type
Loading image…
Option 1
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading…
Loading image…
Loading...
Loading…
Section 2 of 6
District Governor's Welcome
Here is a message from our CNH CKI 2021-2022 District Governor, Ryan Tan!

What's Poppin' California-Nevada-Hawai'i!

I hope you're ready to enter wonderland! You can either go This Way or That Way! This year has definitely flew by, and I cannot believe we're already ending this year! We are one step closer to going down a rabbit hole so I hope you're ready for a wild ride! This event is will be so TAN-talizing and don't forget to Live, Laugh, Love!

Hanna Lam, the District Convention Chair, and her committee has been working tirelessly to make this a truly unforgettable experience! This will be a memorable event that will conclude your wonderland this term so make sure to always know you have a home in CNH! So whether you are running or wandering home to CNH you're always welcome! So join us at District Convention 2022!

With Sunshine,
Ryan Kenneth Tan
2021-2022 District Governor
Section 3 of 6
General Information
Name
Question Type
Format: (Last Name, First Name)
Loading image…
Answer key
(0 points)
Loading...
Loading…
Pronouns
Question Type
Loading image…
She/Her/Hers
He/Him/His
They/Them/Theirs
Prefer Not To Say
Other:
Add option
Answer key
(0 points)
Loading...
Loading…
Gender
Question Type
Loading image…
Female
Male
Non-Binary
Prefer Not To Say
Other:
Add option
Answer key
(0 points)
Loading...
Loading…
Phone Number
Question Type
Format: xxx-xxx-xxxx
Loading image…
Answer key
(0 points)
Loading...
Loading…
Email
Question Type
Loading image…
Answer key
(0 points)
Loading...
Loading…
Position in Home Club
Question Type
"General Member" includes those serving on A-Board
Loading image…
E-Board Member
General Member
Kiwanian
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading…
Are you a DCON Committee Member?
Question Type
Loading image…
Yes
No
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading…
Are you a GRADUATING SENIOR?
Question Type
A GRADUATING SENIOR is defined as someone who is graduating from a four-year or a two-year college as Class of 2022. A student graduating from a two-year college and transferring to a four-year college counts as graduating senior.
Loading image…
Yes
No
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading…
If you are a GRADUATING SENIOR, but continuing in school, where will you be going to school next?
Question Type
Loading image…
Answer key
(0 points)
Loading...
Loading…
Section 4 of 6
General Questions (cont.)
Dietary Preference
Question Type
Loading image…
Standard
Vegetarian
Gluten-Free
Other:
Add option
Answer key
(0 points)
Loading...
Loading…
Please note any food allergies (if any)
Question Type
Loading image…
Answer key
(0 points)
Loading...
Loading…
T-shirt Size
Question Type
Loading image…
S
M
L
XL
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading…
Section 5 of 6
Registration Forms + Fees
All DCON 2022 attendees must be FULLY vaccinated, including a booster if it has been at least 6 month after all recommended doses. It is also mandatory to complete the ATTENDANCE AGREEMENT, CODE OF CONDUCT AND DRESS CODE, RELEASE OF LIABILITY, and COVID WAIVER prior to submitting this registration form. Please give your them to your respective club representative.

The following forms can be found on the DCON 2022 Website at https://dcon.cnhcirclek.org/forms.html under Registration Documents.

Early registration will close on Thursday, February 17th AT 11:59 PM PDT / 8:59 PM HST at $190 per person.
General Registration will close on Thursday, February 24th AT 11:59 PM PDT / 8:59 PM HST at $215 per person.
Are you registering under Early or General Registration?
Question Type
Early Registration: registering before/on February 17, 2022; General Registration: registering after February 17, 2022, by February 24, 2022
Loading image…
Early Registration
General Registration
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading…
I have printed out, completed, and gave my ATTENDANCE AGREEMENT to my club representative
Question Type
Loading image…
Yes
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading…
I have printed out, completed, and gave my CODE OF CONDUCT AND DRESS CODE to my club representative
Question Type
Loading image…
Yes
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading…
I have printed out, completed, and gave my RELEASE OF LIABILITY to my club representative
Question Type
Loading image…
Yes
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading…
I have printed out, completed, and gave my COVID WAIVER to my club representative
Question Type
Loading image…
Yes
Add option
or
add "Other"
Answer key
(0 points)
Loading...
Loading…
Proof of COVID-19 Vaccinations
Question Type
All DCON 2022 attendees must be FULLY vaccinated, including a booster if it has been at least 6 month after all recommended doses. Please attached your proof of COVID-19 Vaccinations below.
Loading image…
Add file
View folder
Allow only specific file types
Maximum number of files
Maximum file size
View folder
Answer key
(0 points)
Loading...
Loading…
Section 6 of 6
Closing Remarks
Thank you for taking time out of your day to complete the District Convention 2022 Registration Form! Please double check your answers to ensure all information is correct prior to submitting.

Now get excited for this adventure in the Wonderland! 🌟
Questions, comments, or concerns?
Question Type
Loading image…
Answer key
(0 points)
Loading...
Loading…
Link to Sheets
Message for respondents
This form is no longer accepting responses
Insights
Total points distribution
Loading...
Loading responses…
Copy chart
No responses yet for this question.
District Governor's Welcome
General Information
Name
Copy chart
No responses yet for this question.
Pronouns
Copy chart
No responses yet for this question.
Gender
Copy chart
No responses yet for this question.
Phone Number
Copy chart
No responses yet for this question.
Email
Copy chart
No responses yet for this question.
Position in Home Club
Copy chart
No responses yet for this question.
Are you a DCON Committee Member?
Copy chart
No responses yet for this question.
Are you a GRADUATING SENIOR?
Copy chart
No responses yet for this question.
If you are a GRADUATING SENIOR, but continuing in school, where will you be going to school next?
Copy chart
No responses yet for this question.
General Questions (cont.)
Dietary Preference
Copy chart
No responses yet for this question.
Please note any food allergies (if any)
Copy chart
No responses yet for this question.
T-shirt Size
Copy chart
No responses yet for this question.
Registration Forms + Fees
Are you registering under Early or General Registration?
Copy chart
No responses yet for this question.
I have printed out, completed, and gave my ATTENDANCE AGREEMENT to my club representative
Copy chart
No responses yet for this question.
I have printed out, completed, and gave my CODE OF CONDUCT AND DRESS CODE to my club representative
Copy chart
No responses yet for this question.
I have printed out, completed, and gave my RELEASE OF LIABILITY to my club representative
Copy chart
No responses yet for this question.
I have printed out, completed, and gave my COVID WAIVER to my club representative
Copy chart
No responses yet for this question.
Proof of COVID-19 Vaccinations
No responses yet for this question.
Closing Remarks
Questions, comments, or concerns?
No responses yet for this question.
Settings
Responses
Manage how responses are collected and protected
Presentation
Manage how the form and responses are presented
Defaults
Form defaults
Settings applied to this form and new forms
Question defaults
Settings applied to all new questions
.