Key Club DLC 2024 | Kiwanis Indiana District

Location:
Crowne Plaza Indianapolis Airport
(2501 S High School Rd, Indianapolis, Indiana)

Date:
March 1st – 3rd, 2024

Cost:

– Member $350
– Chaperone in a double $425
– Chaperone in a single $500

Have Key Clubbers print and fill out these forms:

Agreeing to this event means you agree to follow Key Club’s Code of Conduct
Key Club Medical Form

*THE TOTAL AMOUNT DUE is shown at the bottom of this page.
PLEASE MAKE SURE TO CLICK THE SUBMIT BUTTON AT THE END OF THIS PAGE TO COMPLETE THE REGISTRATION.

**If you have registered correctly, you will receive a confirmation email from indkiw@indkiw.org.

DLC 2024 Registration Form

Home Club Name(Required)

Advisor’s Name(Required)

First Last

Advisor's Phone(Required)

Advisor’s Email(Required)

If you will not be the chaperone for your students attending DLC, list below the adult who will be responsible for the students you are registering. Note: The Kiwanis Youth Protection Policy states: A minimum of one adult per 10 students must be serving as chaperones during the entirety of the event.

Enter your Registrants' info below

*You can register up to 20 registrants

Registration #01

(#01) Registering for DLC as a/an:

Name (#01)

First Last

Key Club Membership Number (#01) (Not needed for advisors)

Phone (#01)

Registrant's Identified Gender (#01)

Female

Male

Email (#01)

Address (#01)

Street Address Address Line 2 City State ZIP Code

Special Needs (Dietary, Physical, etc.) (#01)

Are there any accommodations that you or members in your group would need to make DLC more enjoyable? (#01)

T-shirt size (#01)

Adult Small

Adult Medium

Adult Large

Adult X Large

Adult XX Large

Adult XXX Large

Registration #2

(#02) Registering for DLC as a/an:

Name (#02)

First Last

Key Club Membership Number (#02) (Not needed for advisors)

Phone Number (#02)

Registrant's Identified Gender (#02)

Female

Male

Email (#02)

Address (#02)

Street Address Address Line 2 City State ZIP Code

Special Needs (Dietary, Physical, etc.) (#02)

Are there any accommodations that you or members in your group would need to make DLC more enjoyable?(#02)

T-shirt size (#02)

Adult Small

Adult Medium

Adult Large

Adult X Large

Adult XX Large

Adult XXX Large

Registration #03

(#03) Registering for DLC as a/an:

Name (#03)

First Last

Key Club Membership Number (#03) (Not needed for advisors)

Phone Number (#03)

Registrant's Identified Gender (#03)

Female

Male

Email (#03)

Address (#03)

Street Address Address Line 2 City State ZIP Code

Special Needs (Dietary, Physical, etc.) (#03)

Are there any accommodations that you or members in your group would need to make DLC more enjoyable?(#03)

T-shirt size (#03)

Adult Small

Adult Medium

Adult Large

Adult X Large

Adult XX Large

Adult XXX Large

Registration #04

(#04) Registering for DLC as a/an:

Name (#04)

First Last

Key Club Membership Number (#04) (Not needed for advisors)

Registrant's Identified Gender (#04)

Female

Male

Email (#04)

Address (#04)

Street Address Address Line 2 City State ZIP Code

Special Needs (Dietary, Physical, etc.) (#04)

Are there any accommodations that you or members in your group would need to make DLC more enjoyable?(#04)

T-shirt size (#04)

Adult Small

Adult Medium

Adult Large

Adult X Large

Adult XX Large

Adult XXX Large

Registration #05

(#05) Registering for DLC as a/an:

Name (#05)

First Last

Key Club Membership Number (#05) (Not needed for advisors)

Registrant's Identified Gender (#05)

Female

Male

Email (#05)

Address (#05)

Street Address Address Line 2 City State ZIP Code

Special Needs (Dietary, Physical, etc.) (#05)

Are there any accommodations that you or members in your group would need to make DLC more enjoyable?(#05)

T-shirt size (#05)

Adult Small

Adult Medium

Adult Large

Adult X Large

Adult XX Large

Adult XXX Large

Registration #06

(#06) Registering for DLC as a/an:

Name (#06)

First Last

Key Club Membership Number (#06) (Not needed for advisors)

Registrant's Identified Gender (#06)

Female

Male

Email (#06)

Address (#06)

Street Address Address Line 2 City State ZIP Code

Special Needs (Dietary, Physical, etc.) (#06)

Are there any accommodations that you or members in your group would need to make DLC more enjoyable? (#06)

T-shirt size (#06)

Adult Small

Adult Medium

Adult Large

Adult X Large

Adult XX Large

Adult XXX Large

Registration #07

(#07) Registering for DLC as a/an:

Name (#07)

First Last

Key Club Membership Number (#07) (Not needed for advisors)

Registrant's Identified Gender (#07)

Female

Male

Email (#07)

Address (#07)

Street Address Address Line 2 City State ZIP Code

Special Needs (Dietary, Physical, etc.) (#07)

Are there any accommodations that you or members in your group would need to make DLC more enjoyable? (#07)

T-shirt size (#07)

Adult Small

Adult Medium

Adult Large

Adult X Large

Adult XX Large

Adult XXX Large

Registration #08

(#08) Registering for DLC as a/an:

Name (#08)

First Last

Key Club Membership Number (#08) (Not needed for advisors)

Registrant's Identified Gender (#08)

Female

Male

Email (#08)

Address (#08)

Street Address Address Line 2 City State ZIP Code

Special Needs (Dietary, Physical, etc.) (#08)

Are there any accommodations that you or members in your group would need to make DLC more enjoyable? (#08)

T-shirt size (#08)

Adult Small

Adult Medium

Adult Large

Adult X Large

Adult XX Large

Adult XXX Large

Registration #09

(#09) Registering for DLC as a/an:

Name (#09)

First Last

Key Club Membership Number (#09) (Not needed for advisors)

Registrant's Identified Gender (#09)

Female

Male

Email (#09)

Address (#09)

Street Address Address Line 2 City State ZIP Code

Special Needs (Dietary, Physical, etc.) (#09)

Are there any accommodations that you or members in your group would need to make DLC more enjoyable? (#09)

T-shirt size (#09)

Adult Small

Adult Medium

Adult Large

Adult X Large

Adult XX Large

Adult XXX Large

Registration #10

(#10) Registering for DLC as a/an:

Name (#10)

First Last

Key Club Membership Number (#10) (Not needed for advisors)

Registrant's Identified Gender (#11)

Female

Male

Email (#10)

Address (#10)

Street Address Address Line 2 City State ZIP Code

Special Needs (Dietary, Physical, etc.) (#10)

Are there any accommodations that you or members in your group would need to make DLC more enjoyable?(#10)

T-shirt size (#10)

Adult Small

Adult Medium

Adult Large

Adult X Large

Adult XX Large

Adult XXX Large

Registration #11

(#11) Registering for DLC as a/an:

Name (#11)

First Last

Key Club Membership Number (#11) (Not needed for advisors)

Registrant's Identified Gender (#11)

Female

Male

Email (#11)

Address (#11)

Street Address Address Line 2 City State ZIP Code

Special Needs (Dietary, Physical, etc.) (#11)

Are there any accommodations that you or members in your group would need to make DLC more enjoyable?(#11)

T-shirt size (#11)

Adult Small

Adult Medium

Adult Large

Adult X Large

Adult XX Large

Adult XXX Large

Registration #12

(#12) Registering for DLC as a/an:

Name (#12)

First Last

Key Club Membership Number (#12) (Not needed for advisors)

Registrant's Identified Gender (#12)

Female

Male

Email (#12)

Address (#12)

Street Address Address Line 2 City State ZIP Code

Special Needs (Dietary, Physical, etc.) (#12)

Are there any accommodations that you or members in your group would need to make DLC more enjoyable? (#12)

T-shirt size (#12)

Adult Small

Adult Medium

Adult Large

Adult X Large

Adult XX Large

Adult XXX Large

Registration #13

(#13) Registering for DLC as a/an:

Name (#13)

First Last

Key Club Membership Number (#13) (Not needed for advisors)

Registrant's Identified Gender (#13)

Female

Male

Email (#13)

Address (#13)

Street Address Address Line 2 City State ZIP Code

Special Needs (Dietary, Physical, etc.) (#13)

Are there any accommodations that you or members in your group would need to make DLC more enjoyable? (#13)

T-shirt size (#13)

Adult Small

Adult Medium

Adult Large

Adult X Large

Adult XX Large

Adult XXX Large

Registration #14

(#14) Registering for DLC as a/an:

Name (#14)

First Last

Key Club Membership Number (#14) (Not needed for advisors)

Registrant's Identified Gender (#14)

Female

Male

Email (#14)

Address (#14)

Street Address Address Line 2 City State ZIP Code

Special Needs (Dietary, Physical, etc.) (#14)

Are there any accommodations that you or members in your group would need to make DLC more enjoyable?(#14)

T-shirt size (#14)

Adult Small

Adult Medium

Adult Large

Adult X Large

Adult XX Large

Adult XXX Large

Registration #15

(#15) Registering for DLC as a/an:

Name (#15)

First Last

Key Club Membership Number (#15) (Not needed for advisors)

Registrant's Identified Gender (#16)

Female

Male

Email (#15)

Address (#15)

Street Address Address Line 2 City State ZIP Code

Special Needs (Dietary, Physical, etc.) (#15)

Are there any accommodations that you or members in your group would need to make DLC more enjoyable?(#15)

T-shirt size (#15)

Adult Small

Adult Medium

Adult Large

Adult X Large

Adult XX Large

Adult XXX Large

Registration #16

(#16) Registering for DLC as a/an:

Name (#16)

First Last

Key Club Membership Number (#16) (Not needed for advisors)

Registrant's Identified Gender (#15)

Female

Male

Email (#16)

Address (#16)

Street Address Address Line 2 City State ZIP Code

Special Needs (Dietary, Physical, etc.) (#16)

Are there any accommodations that you or members in your group would need to make DLC more enjoyable?(#16)

T-shirt size (#16)

Adult Small

Adult Medium

Adult Large

Adult X Large

Adult XX Large

Adult XXX Large

Registration #17

(#17) Registering for DLC as a/an:

Name (#17)

First Last

Key Club Membership Number (#17) (Not needed for advisors)

Registrant's Identified Gender (#17)

Female

Male

Email (#17)

Address (#17)

Street Address Address Line 2 City State ZIP Code

Special Needs (Dietary, Physical, etc.) (#17)

Are there any accommodations that you or members in your group would need to make DLC more enjoyable?(#17)

T-shirt size (#17)

Adult Small

Adult Medium

Adult Large

Adult X Large

Adult XX Large

Adult XXX Large

Registration #18

(#18) Registering for DLC as a/an:

Name (#18)

First Last

Key Club Membership Number (#18) (Not needed for advisors)

Registrant's Identified Gender (#18)

Female

Male

Email (#18)

Address (#18)

Street Address Address Line 2 City State ZIP Code

Special Needs (Dietary, Physical, etc.) (#18)

Are there any accommodations that you or members in your group would need to make DLC more enjoyable?(#18)

T-shirt size (#18)

Adult Small

Adult Medium

Adult Large

Adult X Large

Adult XX Large

Adult XXX Large

Registration #19

(#19) Registering for DLC as a/an:

Name (#19)

First Last

Key Club Membership Number (#19) (Not needed for advisors)

Registrant's Identified Gender (#19)

Female

Male

Email (#19)

Address (#19)

Street Address Address Line 2 City State ZIP Code

Special Needs (Dietary, Physical, etc.) (#19)

Are there any accommodations that you or members in your group would need to make DLC more enjoyable? (#19)

T-shirt size (#19)

Adult Small

Adult Medium

Adult Large

Adult X Large

Adult XX Large

Adult XXX Large

Registration #20

(#20) Registering for DLC as a/an:

Name (#20)

First Last

Key Club Membership Number (#20) (Not needed for advisors)

Registrant's Identified Gender (#20)

Female

Male

Email (#20)

Address (#20)

Street Address Address Line 2 City State ZIP Code

Special Needs (Dietary, Physical, etc.) (#20)

Are there any accommodations that you or members in your group would need to make DLC more enjoyable?(#20)

T-shirt size (#20)

Adult Small

Adult Medium

Adult Large

Adult X Large

Adult XX Large

Adult XXX Large

Total Amount Due

Checks for registration should be sent to Indiana District Key Club International
c/o Heidi Polizotto
23 Deep River Drive
Hobart, IN 46342

Checks should be payable to
Indiana District of Kiwanis, Key Club International