2016

Alpha Delta Kappa Gulf Region Conference June 29-July 1, 2016

Jackson Marriott, 200 E. Amite St., Jackson, MS. 39201
“Making Connections….Cultivating Success”

Name Last, First_____________________________________ Name on Badge___________________
Address (Street, City, State, Zip)__________________________________________________________
Home Phone#___________________________________Cell Phone #____________________________
Emergency Contact Name_____________________________Emergency Phone #_________________
Chapter (State and Name)________________________________Current Office___________________
Email Address:________________________________________________________________________________
Food Allergies:_________________________________Banquet Choice: ___Salmon or ___Pork Loin
Member Registration includes Registration Packet, General Sessions, Workshop, Reception, Luncheon,
Evening of Entertainment, Banquet, Favors, and “Swag Bag.”
_____Full Registration Received by May 25, 2016 $130.00 $__________________
_____Late Registration Received by May 26 – June 17, 2016 $150.00 $__________________
_____On-site Registration $180.00 $_________________
Special Events
_____S/N Leadership/Membership Luncheon $ 28.00 $__________________
(S/N Membership Team, IC members & Little Wigs invited)
_____Past State/National Presidents’ Breakfast $ 25.00 $___________________
(I was State/National President of _____ during the ______ biennium.)
Guest Tickets and Regioneer & Gulf Region Pin Order
_____ Reception: name of guest(s)_____________________(#___) $ 20.00_____________________
_____ Luncheon: name of guest(s)_____________________(#___) $ 35.00_____________________
_____ Banquet: name of guest(s)______________________(#___) $ 50.00 ____________________
Gulf Region Pin (optional) $ 5.00 ____________________
th
Regioneer Pin (optional, if this is your 5 conference) $ 5.00 ____________________
(Check all that apply) TOTAL $__________________________
___S/N Officer _____________________________ District Chairman______________________________
___Past Regional International Vice President (Region and Date)__________________________________
___Past International Chapter (Dates)_______________________________________________________
___Chapter Officer (2016-2018)____________________________________________________________
___Golden Sister (50 years) ___Sapphire Sister (35 years) ___Silver Sister (25 years)
___First Timer to a Gulf Conference ___Regioneer (has attended five (5) or more conferences
___Gulf Chorus Volunteer __ Instrument Ensemble Volunteer (Practice on Tuesday, June 28, 8:15 p.m.)
___Assistant Sergeant-at-Arms (meeting Tuesday, June 28, 4:15)
WORKSHOPS – List the number of your chosen workshop session beside the letter. Workshop
descriptions are available in this packet and on the Gulf Region section of the International website.
A_____B_____C_____D_____E_____F_____ G_____
Make checks payable to: ΑΔΚ GRC; Mail to: Gretchen Waters, 126 Chandler Rd., Purvis, MS., 39475-
4154; Cancellation Policy: Requests for refund must be in writing by June 17, 2016. Hotel Reservations:
Book your group rate for Alpha Delta Kappa Regional Conference Gulf Region Cost of the room is
$129 (+tax) + $6.oo parking per night. Check in is: 3:00 p.m.