GCKY Convention Registration Mt. Laurel 75th District Meeting YOUR CONTACT INFORMATION Your Full Name * You can include titles, nicknames, etc. Last Name Only * To help us alphabetize Email Address * An Email Address is required for this form. If you don't have one, please enter info@gardenclubky.org Phone Number Address Address Address Address City City State KY Alabama Alaska Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP Code ZIP Code CONSULTANTS Consultants Landscaping Design Consultant Gardening Consultant Environmental Study Consultant Flower Show Judge Please check ALL that apply GARDEN CLUB MEMBERSHIP Life Membership GCKY Life Member SAR Life Member NGC Life Member Type of Club Local GCKY Club GCKY Member at Large Outside KentuckyOutside Kentucky Guest If you're not in a KY club, you can enter the name of your state and club here. GCKY District Audubon Blue Grass Dogwood Limestone Mountain Laurel Please select your local club from the list that appears after your district is chosen. You may need to wait a few seconds. GCKY Club GCKY Local Club Representative Club President Club Delegate Alternate For Voting at the General Assembly, each club gets a President or (if the president can't attend) an Alternate, plus one delegate for every ten members or fraction thereof. You may select only one option. GCKY POSITIONS AND OFFICES If you are a district director or hold a position at the state level, please mark ALL the appropriate boxes. GCKY Elected Officer GCKY President GCKY V. President (1,2,3) GCKY Recording Secretary GCKY Treasurer District Director GCKY Advisory Board Chair of Advisory Board Advisor to District Directors Past GCKY President GCKY Appointed Officer Corresponding Secretary Parliamentarian Financial Advisor Bylaws Chair Bulletin Editor Fund Raiser Historian Chaplain Board of Trustees Chair Officers appointed by the President shall be the Corresponding Secretary, Parliamentarian, Financial Advisor, Bylaws Chairman, Fund Raiser, Historian, Bulletin Editor, Chaplain, and Board of Trustees Chairman. GCKY Committee Chair Please enter the committee(s) REGIONAL AND NATIONAL POSITIONS If you are involved at the regional or national level, please mark ALL the appropriate boxes. Regional Level SAR Chair SAR Director SAR OfficerSAR Officer For the Southern Atlantic Region National Level NGC Chair NGC OfficerNGC Officer Comments ADMIN reCAPTCHA Sorry for the inconvenience, but we have to block spammers. If you are human, leave this field blank.
