» Resort & Spa » Ocean Activities » Golf Tournament » Educational Sessions » Ocean View Rooms For more information call 808-737-1991 or email [email protected] May 19-21, 2017 Kaanapali Sheraton - Maui 2016-17 D5000 CONFERENCE Conference Chairs Joanne & Larry Laird REGISTRATION FORM Name:___________________________________________________________ Rotary Club ___________________________ Address: ______________________________________________________________________________________________ City: ________________________________________________________ State: _________ Zip _______________________ Phone: __________________________ Email: ______________________________________________________________________ Number of Guests Attending: _____________ Name(s): _____________________________________________________________________ 2016-17 D5000 Conference DOING GOOD in the World Room Rates: $199+ OPTIONS: q Full Conference Registration Including all meals: Early Bird - $335 (Deadline is November 30, 2016) Normal Price - $399 q Ala Carte Conference Registration: $50 (Extra choices below) q Friday Evening Reception: $50 q Saturday Breakfast: $50 q Saturday Lunch: $50 q Saturday Evening Gala & Million Dollar Dinner: $175 q Sunday Brunch: $50 TOTAL: __________ PAYMENT INFORMATION Name:________________________________________________ Credit Card No: _________________________________________ Card Type: q VISA q MASTERCARD q AMEX Exp Date: ________________CVV Code: ____________________ Billing Address: _________________________________________ City: ________________________ State:_____ Zip: ___________ Please make checks payable to: Rotary D5000