Maine State Council129th Anniversary1896-2024 REGISTRATION FORM FOR WINTER MEETING FAIRFIELD INN – 400 ODLIN RD, BANGOR, MAINE January 3 -4, 2025  Problems with this form?Email dan.lalonde@maineknights.net Registration Invitation Passphrase (do not press enter)State Officer Registration (All rooms feature one King Bed unless you request a Two-Bed room under your special requests.) If you don’t need a room, notate it under Special Requests, and let us know how many meals will be needed.Position/title and/or DistrictName(Required) First Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Email(Required) Enter Email Confirm Email Name of Spouse (if applicable)Number in party:(Required)Arrival Date(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Arrival Time Hours : Minutes AM PM AM/PM Departure Date(Required)MonthMonth123456789101112DayDay12345678910111213141516171819202122232425262728293031YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Departure Time Hours : Minutes AM PM AM/PM Special NeedsDietary NeedsBe aware, if two staff members are sharing a room, one member must take payment and registration responsibility. Please provide the name of the second staff member below.(All rooms feature one King Bed unless you request a Two-Bed room under your special requests.)Room Sharing - Name First Last State Staff/PSD $300 covers 2 night’s accommodations & all meals $500 covers 2 night’s accommodation & all meals for two staff sharing a room ($250 for each) $200 covers 1 night’s accommodations & all meals (Either night is the same price) $65 covers meals only for those commuting on Saturday, I would love for everyone to stay thru Mass. (All rooms feature one King Bed unless you request a Two-Bed room under your special requests.)Remember that you will be reimbursed for this entire amount, as well as your round-trip mileage. If your wife (if applicable) is in attendance, you will receive an extra $35 per day allowance.DD Registration $520 covers Friday & Saturday night accommodation & all meals. $110 will cover all meals for you and your wife (if applicable) if you are commuting only. Agency Registration $500 covers Friday & Saturday night accommodation & all meals. $350 covers one nights accommodation and one days meals (either night) $75 will cover all meals for you and your wife (if applicable) if you are commuting only. State Deputy Quantity Price: $725.00 Quantity Total Credit Card Cardholder Name Card Details NameThis field is for validation purposes and should be left unchanged. Δ Views: 157