Badge Name: ____District/Agency:

Street Address: City, State, Zip:

Phone Number: Email:

Spouse Name (if attending):

Check One: ( ) District official ( ) State Agency ( ) NACD ( ) District Employee ( ) Auxiliary ( ) NRCS

Other: Title:

No. of Tickets / Types of Tickets / Price / Amount
KACD Annual Convention
Full Pre-Registration: Includes admission to all KACD sessions and 1 ticket to the Tuesday Evening Banquet / $140.00
ADDITIONAL TICKET INFORMATION:
Tour-TBA / $20.00
One Day KACD Registration (postmarked before July 1) / $50.00
One Day KACD Registration (after July 1 and on site) / $60.00
KACD Supervisor’s Leadership Breakfast – Monday, July 10 / $30.00
KACDE Luncheon – Monday, July 10 / $25.00
Kentucky Auxiliary Breakfast-Tuesday, July 11 / $30.00
Kentucky RC&D Council Breakfast – Tuesday, July 11 / $30.00
Additional KACD Banquet Tickets – Tuesday, July 11(before July 1) / $50.00
KACD Banquet Tickets After July 1 and on site / $60.00

Deadline for Pre-Registration is July 1, 2017

TOTAL: $______

Full refunds will be made on advance payments for cancellations on or before July 1, 2017.

Tickets for all meals and tours will be given to you when you check

in at registration and will be required for access to all events.

FORM OF PAYMENT:

Check (payable to KACD) enclosed #______

Please charge my: VISA ___ MasterCard ____ Card # ______

Security Code: ______(3 digits located on the back of the credit card)

Expiration Date: ______Print Name as it appears on card: ______

Checks should be made payable to:

KACD (Kentucky Association of Conservation Districts)

Please return this form by:

Fax – Franklin County Conservation District at 502-699-2161

or

Mail – KACD * 103 Lakeview Ct. * Frankfort, KY 40601

or

Email –

REGISTRATION FOR DISPLAY SPACE

(Conservation Districts: You must register for the Convention in order to hold a display space.

1. County or Company______

2. Name of registrant the display is connected______

3. Electricity? ______

4. Please be aware that you are responsible for all items within your display area.

5. Display space for conservation districts is on a first come, first served basis. Always get this

request in early.

6. All displays may be set up beginning at 1:00 pm July 9 and must be taken down by 12:00 pm

Tuesday July 11th

7. No booths will be reserved without the form submitted by the required registration date (July1,

2017).