Pennsylvania District of Kiwanis International

PA Circle K Registration - Payment Sent to District Office

Type of Registration


Club Information

Primary Registration Contact Person Information

Payment to District Office

Checks may be sent to:
Pennsylvania Kiwanis Office
Re: Circle K InterPACK Registration
2793 Old Post Road, Ste. 12
Harrisburg PA 17110-3683

I understand my/our registration(s) are not complete until a check/Venmo payment is received by the PA Circle K/Kiwanis District Office. Upon completing this form. I will send the payment to the District Office in advance of the event. No registrations will be held without payment being submitted. ***Note: Individuals/clubs paying by check will be responsible for payment even if they do not attend the event unless the registration is properly canceled by contacting the District Office. ****

Registration Fees

Registration - Note: DOES NOT INCLUDE hotel accommodations. In addition, the registration cost will NOT TOTAL BELOW. You WILL be responsible for the number of registrations submitted online with your check payment.

TOTAL: $0.00 @ $105.00

($110.00 after March 14, 2017)

TOTAL: $0.00 @ $25.00

($30.00 after March 14, 2017)

TOTAL: $0.00 @ $80.00

($85.00 after March 14, 2017)

TOTAL: $0.00 @ $50.00

($55.00 after March 14, 2017)

TOTAL: $0.00 @ $35.00

($40.00 after March 14, 2017)

TOTAL: $0.00 @ $10.00

Total Fee: $0.00

For each registrants, including the primary contact, please complete a box below.

Registrant - #1


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