2019 District Convention and Service Project
Sunday, March 31, 2019
9:30 am - 5pm

Service Source, Inc.
10467 White Granite Drive
Oakton, VA 22124

Lunch will be provided

I plan to attend the District Convention & Service Project *
Name *
Your answer
I am with the Junior Civitan Club of *
Position *
Current Grade *
Cell Phone *
Your answer
email *
Your answer
How will you be paying your $10 per person registration fee? *
Will you be running for a District Officer Position? If yes, what position? *
Your answer
Will you be running for an International Officer Position? *
Do you have any food allergies we should be aware of? If so, please explain. *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Cell Phone *
Your answer
Are there any questions or concerns you would like addressed either before or during convention? *
Your answer
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