CALIFORNIA-NEVADA-HAWAII DISTRICT
Circle K International
District Summer Service Social 2015
August 13th – 15th, 2015
Sacramento, California
Registration must be received by July 14th. No on-site registration will be accepted.
First Name:
Last Name:
Address:
City/State/ZIP:
Phone:
Email:
Division/School:
Vegetarian: Yes/No
Participants that register for regular registration must stay in one of the following locations:
o Those who regularly reside within 35 miles from 1209 L Street, Sacramento, CA
95814 may stay at their residence.
o Those from farther away must stay in the Hyatt Regency Sacramento, 1209 L
Street, Sacramento, CA 95814.
***Please read the important message at the bottom of this form to find out more details
about restrictions on housing, traveling, and general registration.
CALIFORNIA -N EVADA -HAWAII D ISTRICT OF C IRCLE K INTERNATIONAL
www.cnhcirclek.org
Kiwanis Professional Center | 8360 Red Oak Street, Suite 201 Rancho Cucamonga, CA 91730
1
REGISTRATION FEE
Please indicate whether you are signing up for regular registration or oneday registration. If you select one-day registration, please indicate the day
that you will attend. One-day registration will be from 8am-8pm.
Total
Registration
Cost = $30
___ Regular registration = $30
___ One-day registration = $30
___ THURSDAY
___ FRIDAY
___ SATURDAY
2
HOUSING
Roommate Names
Please indicate where you will be during DSSS.
___I will stay at my residence within 35 miles of the convention
site.
___I will stay at the arranged housing (Hyatt Regency).
If you plan on staying at your residence, provide the address at which
you will be staying:
1) ________
2) ________
3) ________
Address: _________________________________
Total Housing
Cost:
City, State, ZIP: ____________________________
$ ________
If you plan on staying at the Hyatt Regency, please indicate the nights
that you will be staying in the following table. Also indicate the names
of the roommates with whom you will be staying (maximum is 4 in a
room).
CALIFORNIA -N EVADA -HAWAII D ISTRICT OF C IRCLE K INTERNATIONAL
www.cnhcirclek.org
Kiwanis Professional Center | 8360 Red Oak Street, Suite 201 Rancho Cucamonga, CA 91730
If you will be staying at the Hyatt Regency, please indicate which days you are staying.
Wednesday
Thursday
Friday
Saturday
Aug 12
Aug 13
Aug 14
Aug 15
Total for hotel
(Rate per night
X number of
nights)
Single
occupancy
$ ________
($150.00/night/
person)
Double
occupancy
$ ________
($75.00/night/p
erson)
Triple
occupancy
$ ________
($50.00/night/
person)
Full room
($37.50/night/p
$ ________
erson)
3
TOTAL ENCLOSED
Total Enclosed:
Total Registration Cost + Total Housing Amount
$ ________
CALIFORNIA -N EVADA -HAWAII D ISTRICT OF C IRCLE K INTERNATIONAL
www.cnhcirclek.org
Kiwanis Professional Center | 8360 Red Oak Street, Suite 201 Rancho Cucamonga, CA 91730
Important Message about Housing, Travelling Times, and Registration Restrictions
Circle K members are required to stay in the designated housing while attending the event,
unless they live or regularly reside within 35 miles of the event site. For example, a student
who attends Sac State and has an apartment/house in the Sacramento area may stay in his/her
home. A student who goes to UCSD, but regularly resides in the Sacramento area may also
stay in his/her respective home in the Sacramento area.
Circle K members are considered to be attending a Circle K event from the time they leave
from their residence for the event until they return home. The Circle K Code of
Conduct applies throughout that time. Remember that you are participating in this event as
Circle K members, so please remember to represent your club in an appropriate way and
remind your fellow members to do the same.
One-day registration is not available to every club. Clubs that must travel a great distance will
not be allowed to sign up for one-day registration because this would only result in some clubs
travelling most of the day rather than actually participating in the event activities. For this
reason one-day registration will be restricted to schools in the following divisions:
o Capital
o Golden Gate
o Sunset
If your home club is not from any of these divisions, then you must sign up for regular
registration and you must stay at the hotel if you wish to attend DSSS.
No school/club can arrive past 10pm on Thursday night. If your home club is not eligible to
participate in on- day registration then you cannot arrive any earlier than 12pm on Friday.
Check-in will be occurring on both days, Thursday and Friday. The point of these rules is to
ensure that no Circle K members are on the road between 10pm and 6am.
If you are unclear about these restrictions, please contact Edison Xu before you register in
order to avoid conflict or confusion in the future.
CALIFORNIA -N EVADA -HAWAII D ISTRICT OF C IRCLE K INTERNATIONAL
www.cnhcirclek.org
Kiwanis Professional Center | 8360 Red Oak Street, Suite 201 Rancho Cucamonga, CA 91730
By registering for this event, you are acknowledging these provisions and agreeing to follow
them.
REGISTRATION MUST INCLUDE
 THIS FORM,
 PAYMENT IN A CHECK PAYABLE TO CAL-NEV-HA CIRCLE K,
 AND SIGNED WAIVER FORM AND CODE OF CONDUCT.
NO CREDIT CARDS OR CASH WILL BE ACCEPTED FOR THIS EVENT.
REGISTRATIONS MUST BE RECEIVED BY JULY 14TH. PLEASE SEND TO:
Cal-Nev-Ha Kiwanis District Office
ATTN: Bruce Hennings
8360 Red Oak Street, Suite 201
Rancho Cucamonga, CA 91730
Sign here to show that you have read and understand/agree to all rules and restrictions
described above:
Signature___________________________________________________ Date______________
**A soft copy should also be sent to Edison Xu at service@cnhcirclek.org.**
Please save the registration form in the format of:
“DSSS2015_FirstNameLastName” (example: DSSS2015_EdisonXu)
Please contact Edison Xu with any other questions regarding this form. Thank you!
CALIFORNIA -N EVADA -HAWAII D ISTRICT OF C IRCLE K INTERNATIONAL
www.cnhcirclek.org
Kiwanis Professional Center | 8360 Red Oak Street, Suite 201 Rancho Cucamonga, CA 91730