*Indicates Required Field.

If your school and summer addresses are the same, indicate that by typing "same" in the second set. If you don't put something in the field, it won't submit properly. ALL FIELDS WITH AN ASTERISK MUST BE FILLED IN!! IF YOU DON'T HAVE ANYTHING TO PUT IN ONE OF THESE FIELDS, TYPE A PERIOD OR SOMETHING SO THAT THE FORM WILL STILL SUBMIT. If you still have trouble with the form, use the printable form and mail it in with your check.

If you submit the form and there are errors, use your browser's back button rather than the "back" link. Otherwise, your information will be cleared, and you will have to enter everything again.

*First name:     *Last name: 

*School Mailing Address: 
*City:     *State:     *Zip Code:     *Country: 

*Summer Mailing Address: 
*City:     *State:     *Zip Code:     *Country: 

*Email:

*School Phone Number:    *Summer Phone Number:

Classification:     Age: 

*Club:     *District: 
Office Held, if any: 

Please list any restrictions you have, dietary or otherwise:

*Do you want a t-shirt?   Yes   No

If yes, what size?   Medium   Large   Extra Large   Other:  
You must include $8 extra with your registration to cover the cost of the t-shirt.

*How will you be arriving in St. Louis?

If you will be arriving late, please indicate when you expect to arrive.

Other comments:

You must send $115.00 for registration (plus $8.00 if you want a t-shirt) to

Checks should be made out to Circle K International.

If you have any questions, please call LSSP Chair Cathy Collier at (256) 390-2553 or email Cathy.

Print this form for your records.

Review your registration before clicking submit. Click submit only once.