MidYearConvention-Registration

2018 Mid Year Convention Registration

Please use the form below to register and pay online. We have integrated with Pay Pal which allows you to use all major credit cards as well as debit cards and e-checks. You do NOT need a Pay Pal account to use your credit/debit card. Simply click on the GRAY checkout button when you reach the shopping cart page. Please note, that once the form is submitted containing your registration data you cannot go back and change it. It is okay to submit the registration multiple times however.

* Indicates required field

Elks Member / Delegate Name (First and Last): *

Title: *

Spouse / Guest / 2nd Elks Member Name (First and Last) *

Title (if Elks Member): *

Lodge Name and Number: *

Delegate Phone Number: *

Delegate Email Address: *

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