NCCW 2016 Convention

Catholic Women: Instruments of Mercy

September 7 -10, 2016 Downtown Marriott, Indianapolis, Indiana

PLEASE PRINT ALL INFORMATION BELOW THERE WILL BE NO ON SITE REGISTRATION

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First Name Last Name Preferred Name for badge

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Parish or Subdivision Affiliation Arch/Diocese

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Address City State Zip Code

______Daytime or Cell Phone Email (please print email address)

Voting Delegate (select one): □ Individual □ Parish □ Deanery/District □ Diocese □ Non-Voting (Non-Member or Spiritual Advisor)

Please check those categories that apply to you for Convention ribbons: Current A/Diocesan President ______Individual Member _____

Supporting Member ______Legacy Circle Member ______100th Birthday Club Member ______

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Emergency Contact, while on-site at the Convention Emergency Contact Phone

Do you have any physical, visual, hearing or dietary needs with which NCCW can assist? □ Yes □ No

If yes, please describe: ______

Is this your first NCCW Annual Convention? □ Yes □No Will you attend the First Timers Orientation ___ Yes ___ No

REGISTRATION FEES: Circle the appropriate fees.

Registration Category / Full Convention
(Good thru June 30) / Full Convention
(July 1 – August 23) / OPTIONAL EVENTS / INVITATION ONLY EVENTS
Full includes breakfast with speaker on Friday, Sept. 9th / Full includes breakfast with speaker on Friday, Sept. 9th / Saturday Night Closing Banquet / Fundraiser
Late Nite Catechism / Spiritual Advisor Luncheon*
Only Spiritual Advisors May Attend / Leadership Luncheon **
By Invitation Only
NCCW Board Members
Past NCCW Presidents
Commissions/ Committees
LTD Team Members
Full Convention Registration / $320 / $370 / $78 / $30 / $46 / $49
One Day Registration
Date attending:
______/ $130 / $150 / $78 / $30 / $46 / $49
Spouse of Registrant / $150 / $150 / $78 / $30 / N/A / N/A
Mail/Fax with payment:
Fax: 703-224-0991
Mail: NCCW Annual Convention
200 North Glebe Road, Suite 725
Arlington, VA 22203
Cancellation Policy: There are no refunds, but registration can be transferred / PAY ONLY BY POSTAL SERVICE
TOTAL PAYMENT DUE (from above): $______:
Forms received without payment will not be processed.
□ Check Enclosed (payable to NCCW) Check Number ______Credit Card □ Discover □ MasterCard □ Visa
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Credit Card Number
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Expiration Date (month and year) Security Code
Cardholder Signature

MENU CHOICES FOR SELECT LUNCHEONS:

*SPIRITUAL ADVISORS LUNCH (Spiritual Advisors only): If attending the Spiritual Advisors’ Lunchon Friday, Sept. 9th for $46, please select one of the following entrees:

______Potato crusted chicken with Mornay Sauce, sautéed spinach and mushrooms, double creamed whipped potatoes, asparagus, and roast butternut squash

______Vegetarian Option of Italian Vegetable Manicotti

______Baked Salmon filet with three peppercorn supreme sauce, jasmine rice, asparagus, and roast butternut squash

**Leadership Luncheon (Invitation Only): If you are attending the Leadership Luncheon on Wednesday, September 7th for $49, please select one of the following entrée choices:

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______Parmesan crusted chicken breast stuffed with spinach, mushrooms and cheese with Tomato Basil Cream Sauce with tomato and cheese, pearl pasta risotto, zucchini planks, sautéed spinach and julienne carrots

______Vegetarian Wellington Grilled and steamed vegetables layered with cheese wrapped in puff pastry with tomato basil cream sauce with tomato and cheese, pearl pasta risotto, zucchini planks, sautéed spinach and julienne carrots