FLORIDA DISTRICT CONVENTION REGISTRATION 2021 A registration form must be submitted for each person registering. Make checks payable to and mail to: Florida District, Pilot International Missy Ridgway, Treasurer 79 Pecan Pass • Ocala, FL 34472 Registration must be postmarked by March 25, 2021 to avoid a late fee of $20.00. Registration fee refunds will be considered by the DAC in cases of illness or other unavoidable circumstances. Written requests giving reasons may be made to the District Treasurer within five days prior to the first day of convention. If a request is made after convention, refunds may be made at the discretion of the DAC only if received within 30 days of the close of convention. An administrative fee of $25.00 will be charged on all canceled registrations. Registration will open at 3:00 pm on Friday, April 16, 2021 Number of RegistrationsOne AttendeeTwo AttendeesThree AttendeesParticipant InformationRegistration*Full Registration incl. Saturday Lunch & Banquet; Sunday Breakfast & registration materials ($120.00)Full Registration (Anchors, Compass and PSHF Residents ONLY) Includes: Saturday Lunch & Banquet; Sunday Breakfast and registration materials ($115.00)Partial Registration includes Saturday Lunch and registration materials ($70.00)Saturday Night Banquet Ticket ($50.00)Please check one:* Pilot Co-Pilot Anchor Compass PSHF Guest Past Governor Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Pilot Club*Email* Emergency Contact* First Last Emergency Contact Phone*First Time Attending ConventionYesNoAre You A Club DelegateYesNoSaturday Morning Free made to order breakfast included with your room reservation Saturday Lunch*Roast Beef Sandwich - Shaved Roast Beef Topped w/ Caramelized Onions, Horseradish Cream on a Toasted Bun with Au JusCalifornia Club - Smoked Turkey, Honey Cured Ham, Bacon Rolled in a Flour Tortilla w/ Lettuce, Tomato, Red Onion and Provolone CheeseRoasted Vegetable Wrap - Roasted Zucchini/Yellow Squash Wrapped in a Tomato Tortilla with Spinach, Alfalfa Sprout & Spring Mix Lettuce Drizzled With Balsamic Vinaigrette (Vegetarian, Vegan, Gluten Free)(all choices served with Chef’s Pasta Side, Bag of Chips and Pickle Spear)Saturday Dinner*Prime Rib of Beef - 10 Oz. Herb Crusted and Slow Roasted Served with Horseradish and Au JusHerb Crusted Salmon - 8 Oz Salmon Filet Crusted with Herbs and Pan Seared Dressed in Lemon VeloutéEggplant Parmesan - Lightly Coated with Breadcrumbs and Fried, Layered with Ricotta, Mozzarella and Parmesan Cheese in a Zesty Marinara Sauce (Vegetarian, Vegan, Gluten Free)(all choices served with Mixed Green Salad, Mashed Potato, Vegetable & Dessert)Sunday Breakfast Scrambled Eggs, Seasoned Breakfast Potatoes, Applewood Bacon, Sausage Links, Buttermilk Biscuit, Baked Muffins List Food Allergy or Dietary Restrictions (Not Dislikes):Second Registration InformationRegistration*Full Registration incl. Saturday Lunch & Banquet; Sunday Breakfast & registration materials ($120.00)Full Registration (Anchors, Compass and PSHF Residents ONLY) Includes: Saturday Lunch & Banquet; Sunday Breakfast and registration materials ($115.00)Partial Registration includes Saturday Lunch and registration materials ($70.00)Saturday Night Banquet Ticket ($50.00)Please check one:* Pilot Co-Pilot Anchor Compass PSHF Guest Past Governor Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Pilot Club*First Time Attending ConventionYesNoAre You A Club DelegateYesNoSaturday Morning Free made to order breakfast included with your room reservation Saturday Lunch*Roast Beef Sandwich - Shaved Roast Beef Topped w/ Caramelized Onions, Horseradish Cream on a Toasted Bun with Au JusCalifornia Club - Smoked Turkey, Honey Cured Ham, Bacon Rolled in a Flour Tortilla w/ Lettuce, Tomato, Red Onion and Provolone CheeseRoasted Vegetable Wrap - Roasted Zucchini/Yellow Squash Wrapped in a Tomato Tortilla with Spinach, Alfalfa Sprout & Spring Mix Lettuce Drizzled With Balsamic Vinaigrette (Vegetarian, Vegan, Gluten Free)(all choices served with Chef’s Pasta Side, Bag of Chips and Pickle Spear)Saturday Dinner*Prime Rib of Beef - 10 Oz. Herb Crusted and Slow Roasted Served with Horseradish and Au JusHerb Crusted Salmon - 8 Oz Salmon Filet Crusted with Herbs and Pan Seared Dressed in Lemon VeloutéEggplant Parmesan - Lightly Coated with Breadcrumbs and Fried, Layered with Ricotta, Mozzarella and Parmesan Cheese in a Zesty Marinara Sauce (Vegetarian, Vegan, Gluten Free)(all choices served with Mixed Green Salad, Mashed Potato, Vegetable & Dessert)Sunday Breakfast Scrambled Eggs, Seasoned Breakfast Potatoes, Applewood Bacon, Sausage Links, Buttermilk Biscuit, Baked Muffins List Food Allergy or Dietary Restrictions (Not Dislikes):Third Registration InformationRegistration*Full Registration incl. Saturday Lunch & Banquet; Sunday Breakfast & registration materials ($120.00)Full Registration (Anchors, Compass and PSHF Residents ONLY) Includes: Saturday Lunch & Banquet; Sunday Breakfast and registration materials ($115.00)Partial Registration includes Saturday Lunch and registration materials ($70.00)Saturday Night Banquet Ticket ($50.00)Please check one:* Pilot Co-Pilot Anchor Compass PSHF Guest Past Governor Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Pilot Club*First Time Attending ConventionYesNoAre You A Club DelegateYesNoSaturday Morning Free made to order breakfast included with your room reservation Saturday Lunch*Roast Beef Sandwich - Shaved Roast Beef Topped w/ Caramelized Onions, Horseradish Cream on a Toasted Bun with Au JusCalifornia Club - Smoked Turkey, Honey Cured Ham, Bacon Rolled in a Flour Tortilla w/ Lettuce, Tomato, Red Onion and Provolone CheeseRoasted Vegetable Wrap - Roasted Zucchini/Yellow Squash Wrapped in a Tomato Tortilla with Spinach, Alfalfa Sprout & Spring Mix Lettuce Drizzled With Balsamic Vinaigrette (Vegetarian, Vegan, Gluten Free)(all choices served with Chef’s Pasta Side, Bag of Chips and Pickle Spear)Saturday Dinner*Prime Rib of Beef - 10 Oz. Herb Crusted and Slow Roasted Served with Horseradish and Au JusHerb Crusted Salmon - 8 Oz Salmon Filet Crusted with Herbs and Pan Seared Dressed in Lemon VeloutéEggplant Parmesan - Lightly Coated with Breadcrumbs and Fried, Layered with Ricotta, Mozzarella and Parmesan Cheese in a Zesty Marinara Sauce (Vegetarian, Vegan, Gluten Free)(all choices served with Mixed Green Salad, Mashed Potato, Vegetable & Dessert)Sunday Breakfast Scrambled Eggs, Seasoned Breakfast Potatoes, Applewood Bacon, Sausage Links, Buttermilk Biscuit, Baked Muffins List Food Allergy or Dietary Restrictions (Not Dislikes):Complete Your RegistrationDistrict Code (If Applicable) Total $0.00