Maine State Council128th Anniversary1896-2024 REGISTRATION FORM FOR SUMMER MEETING FAIRFIELD INN – 400 ODLIN RD, BANGOR, MAINE 21 – 23 JUNE 2024 Problems with this form?Email dan.lalonde@maineknights.net Registration Invitation Passphrase (do not press enter) State Officer RegistrationPosition/title and/or District Name(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)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Arrival Time Hours : Minutes AM PM AM/PM Departure Date(Required)Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Departure 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.Room Sharing - Name First Last State Staff/PSD $500 covers 2 night’s accommodation & all meals for two staff sharing a room ($250 for each) $350 covers 2 night’s accommodations & all meals $225 covers 1 night’s accommodations & all meals (Either night is the same price) $75 will cover all meals for you and your wife (if applicable) if you are commuting only. $40 covers meals only for those commuting on Saturday, I would love for everyone to stay thru Mass. 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 $500 covers Friday & Saturday night accommodation & all meals. $75 will cover all meals for you and your wife (if applicable) if you are commuting only. Please pre-pay at registration for the new State Pins. You will each receive 25 pins @ $4.00 per pin; the monies raised from these go to Pro-Life activities. I ask you to sell them to members for $5.00 per pin, which will allow you to give free pins to the priests in your District.State Pin Pack - 25 pins @ $4.00 ea. Price: Quantity12345Agency 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 - elect Quantity Price: $675.00 Quantity Total Credit Card Cardholder Name Card Details PhoneThis field is for validation purposes and should be left unchanged. Δ Views: 22
