Registration Form

Please complete this online form to register for International Convention.
This registration form and a $500.00 deposit are due by Friday, May 3, 2024.
 
Checks should be made payable to "New York Key Club Tour" and mailed to:
 
John Goldstein
590 Mullock Road
Port Jervis, NY  12771
ATTN:  ICON 2024
 
*Deposits are non-refundable

Personal Information

Gender *
 +

Key Club Information

Will you be one of your club's two delegates? *
Have you attended ICON before? *
From which region will you depart? *

Emergency Contact

Please provide two (2) emergency contacts, at least one who resides in your permanent home.
Dietary Restrictions (select all that apply) *
 

Required Documents


Click here for the Medical Form

Click here for the Code of Conduct

Click here for the Photo Release

Registration Form and $500.00 Deposit Due: May 3, 2024

Checks should be made payable to "New York Key Club Tour" and mailed to:
 
John Goldstein
590 Mullock Road
Port Jervis, NY  12771
ATTN:  ICON 2023