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Home
About Us
Our Mission
Core Values Of DeMolay
What Do Our Members Do?
Join
DeMolay
Squire
Membership Forms
Chapters
Library
Important Documents and Links
LCC
Membership Forms
Form 10
Scholarship Information
Yearbooks
News
Events
Calendar
Payment
Contact
Convention - Adult Form
Adult Registration - Colorado Convention 2022
Name
Chapter/Jurisdiction/Position/Title for Introduction
Phone
Email
Address
Shirt Size
- Select -
Sm.
Med.
Lg.
X Lg.
2 XL
3 XL
4 XL - Limited quantities
Awards and Honors received
Amount Per Room
- Select -
4 Per Room ($280.00 - Regular Registration) - If available, Includes meals, weekend activities, and dance.
3 Per Room ($310.00 - Regular Registration) - If available, Includes meals, weekend activities, and dance.
2 Per Room (400.00 - Regular Registration) - If available, Includes meals, weekend activities, and dance.
Single Room ($600.00 - Regular Registration) - If available, - Includes meals, weekend activities, and dance.
Saturday night banquet ($65.00 - Regular Registration) - Includes dance admission
Saturday night Dance Only ($15.00 - Regular Registration) - Dance admission only
Dinner Choice
- Select -
Seared Sirloin, Gremolata, Asparagus, Charred tomato, White cheddar mashed potatoes. Served with mixed green salad, and chocolate torte
Seared chicken breast, baby carrots, and rice pilaf. Served with mixed green salad, and chocolate torte
Vegetable Option
Gluten Free
Release
Release Statement
?
I hereby release Colorado DeMolay from all responsibility and liability for any illness or injury that I may sustain during this activity.
I hereby release Colorado DeMolay from all responsibility and liability for any illness or injury that I may sustain during this activity. In the event of an emergency, I hereby authorize an adult leader of this activity as agent for me, to consent to any x-ray examination, medical, dental or surgical diagnosis, treatment and hospital care advised and supervised by a physician, surgeon, dentist (as appropriate), licensed to practice under the laws of the state where services are begin rendered, either at a Doctor's office or in any hospital.
Electronic Signature
Reset
Sign Date
Emergency Information
Emergency Phone #1
Emergency Phone #2
Allergies
Medications Currently Being Taken
Physical Handicaps
Medical Insurance Provider
Name of Policy Holder
Policy Number
?
Agreement of Guidelines and Waivers
Waiver Statement
I understand that a physical copy of waiver forms required for any event must be scanned and turned in as part of my registration
I have read and agree to the guidelines
I have provided current and accurate information
I have read, understand, and agree to all required release waivers.
I Accept
By selecting "I accept" you consent to be bound by all conditions and terms. You also agree that your electronic signature throughout this form will serve as the legal equivalent of your manual signature.
Final Electronic signature
Reset
Electronic Signature acceptance date
Submit
Leave this field blank
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