Registration D28 Toastmasters Conference Registration Please fill out the following fields to complete your conference registration. Payment is made securely with PayPal at the end of the registration process. Congratulations! You made it in time for the $10 Early Bird discount on a Full Package or Saturday with Meals ticket. Registration Type*ToastmasterGuestPlease choose whether this registration is for a Toastmaster or a Guest.Name*FirstLastAddress*Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayNorthern Mariana IslandsOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabweCountryEmail*Enter EmailConfirm EmailPhone*Home Club Name*Please enter the name of your home Toastmaster Club. This will be displayed on your name badge.TM DesignationWhat communication or leadership awards have you earned? For example, enter AC-S / CL for Advanced Communicator-Silver / Competent Leader. This will be put on your name badge.Club NumberIf you know it, please enter your Club Number.First Timer?YesIs this your first time attending a Toastmasters Conference? (Expect to receive a First Timer mailing in the near future!)Be a "buddy?"YesConference veterans - Would you be willing to be a “buddy” to a First Timer?Ticket Type*Full Package ($99.00)Friday Fun Night ($25.00)Evaluation Contest ($15.00)Saturday with meals ($85.00)Saturday without meals ($35.00)Saturday AM ($45.00)Saturday PM ($45.00)Saturday Lunch ($25.00)Saturday Contest ($15.00)Saturday Banquet ($35.00)Please select your ticket type. Some tickets require a meal selection.PreregisteredPreregisteredDeduct $20 if you preregisteredFriday Dinner*Vegetarian WrapTurkey Club WrapHam and Swiss on FocacciaPlease select a meal option for Friday evening.Saturday Lunch*Vegetarian Chef's ChoiceBlackened Tilapia FiletLemon Rosemary ChickenPlease select a meal option for Saturday lunch.Saturday Dinner*Vegetarian Chef's ChoiceSwiss SteakParmesan Crusted ChickenPlease select a meal option for the Saturday evening banquet.Currency Exchange*US DollarCanadian DollarOtherPayPal charges an additional fee to handle international transactions.The honor system applies here.Total$0.00Total Ticket Price (includes surcharge for PayPal fees)CommentsIf you have special requests this is the place to let us know.
