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
I am with the Junior Civitan Club of
C.D. Hylton High School
Churchill High School
James Madison High School
Langley High School
Spring Mills High School
St. Mary's High School
Waynesboro Area School District
Yorktown High School
Bishop O'Connell - Club building team
Liberty HS - Club building team
Club Vice President
Other Club Officer
District Board Member -- Junior Civitan
Sponsor Club Liaision
Parent or Chaperone
(adult) District Guest
How will you be paying your $10 per person registration fee?
School check combined with other club members' registration fee on or before March 31st
Check or cash at the door
Other -- if you are a Junior Civitan District Board Member or Guest Speaker
Will you be running for a District Officer Position? If yes, what position?
Will you be running for an International Officer Position?
Do you have any food allergies we should be aware of? If so, please explain.
Emergency Contact Name
Emergency Contact Cell Phone
Are there any questions or concerns you would like addressed either before or during convention?
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