SECTION A

REGISTRATION and
GENERAL INFORMATION

DUE: FEBRUARY 1, 2016

District Convention 2016

Greetings from your Convention Chair-3
Hotel and Venue Information4
5
Advisor Information
Convention Overview-6
Registration Instructions7
Online Registration Instructions-8
Medical Authorization Form--22
Code of Conduct-23
Registration Summary-24
Registration Checklist- 25
House of Delegates-26
Club Delegate Registration27
Service Fair Information
28
Service Fair Registration
29

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District Convention 2016

Ryan Miura
District Convention Chair
503-490-0041
pnwconventionchair@gmail.com
Hello Pacific Northwest Key Clubbers,
I am extremely excited to invite you to the 67th Annual District
Convention. The District Board has been, and will, continue
working hard to ensure this spectacular event will be that:
spectacular. The theme this year is the Future of Service, chosen to emphasize a continued effort towards a better world for
future generations and to remember our contributions now
make a difference in the future. I would like to personally thank
everyone for their own contributions made this year. Whether it
be donating to The Eliminate Project, cleaning up parks and roads, or serving in your own
way, you are making a difference. I hope that we all continue to fully devote ourselves to
our service.
I really want to emphasize the impact of Key Club and the District Convention. Key Club is a
club that offers immense growth opportunities for high school students from completely different walks of life. Our core valuesleadership, character building, caring, and inclusivenesscan be seen in each and every one of our 260,000 members. This club not only offers
service opportunities, but also a place where members can feel safe and be themselves.
District Convention is the cultivation of this. All of our success, our pain, our hardships, and
our greatest achievements are celebrated at this life-changing event, a single event that
has the power to completely change a persons view on the world. I cannot express my
gratitude towards Key Club and towards District Convention. I would not be who I am today without the experiences gained through both. In my preparation for District Convention, I can only hope that I can recreate for you what I experienced two years agoa truly
life-changing experience. I hope to see every one of you 13,629 PNW Key Clubbers at
DCON 2016, and I am looking forward to meeting many of you. If you have any questions,
feel free to contact me anytime.
In love and service,

Ryan Miura
Pacific Northwest District Convention Chair
Key Club International

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District Convention 2016

Hotel and Venue
The convention venue is the Washington State Convention Center, located at 800 Convention Place, Seattle, WA 98101. Housing is at the Seattle Sheraton Hotel, the Seattle Crowne
Plaza Hotel, and the Seattle Hilton Hotel. Any request for proximity to another club or division
cannot be granted. No requests for changes in housing can be made.
Check in time is 3 PM. Chaperones must check in their attendees as a group, and ID will be
required by the chaperones. Attendees arriving before 3 PM are not guaranteed arrival into
rooms. Key Clubbers should go to the Convention Center as advisors check in to avoid clutter in the lobby. Luggage storage will be available at the Convention Center
Check out time is 12:00 Noon.

Parking
To the right is a map to the Washington State Convention Center
Parking Garage. Key Club has a
special discounted rate with
@TheConventionCenter Parking
Garage (NOTE: NOT CONVENTION
PLACE).
Please note that we will be selling
parking passes at the Help Desk
throughout the duration of convention, so park first then head up
to the desk. Parking passes are
available for $15 per day and do
not include in and out privileges.

If your club is traveling by bus, please make your own parking arrangements ahead of time,
as the Convention Center does not provide overnight parking for buses. If this pertains to
your club, please contact the following people:
Safeco Field
Malcom Rogel
206-346-4105
MRogel@mariners.com

Diamond Parking
Gus Rojas
206-729-0241
Gus.rojas@diamondparking.com
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District Convention 2016

All registration materials must be postmarked no later than February 1, 2016.
Please follow the instructions on page 8 on how to submit registration.
If you have any questions about registration please contact keyclubdcon@gmail.com.
Please keep in mind that the postmark deadline is for the forms listed on the Registration
Checklist For Advisors. To ensure time for you to organize and complete all the registration
materials for your club, it is highly recommended that you set a deadline for your students
much sooner.
As you arrive, proceed to the 4th floor of the Convention Center to room 4C, for registration
and luggage storage. There may be numerous boxes of registration materials to pick up, so
we suggest advisors bring one or two Key Clubbers to assist in carrying the items.
There will be division time on Friday night, plus some time to change. Friday dinner and Saturday lunch are provided. Breakfast items will be available for purchase on Saturday morning for a nominal fee. Also, clubs will be given a list of restaurants and eateries within walking distance of the Convention Center for dinner on Saturday evening. Please plan these
meals for your club accordingly.
There will be an orientation meeting Friday evening at 9:30 PM during caucusing for advisors
and chaperones. This will include updates on the schedule and the weekend. This meeting
is mandatory.
For safety reasons, please remember that Key Clubbers may not leave their assigned hotel
after curfew and advisors must confirm students are in their assigned rooms before retiring
for the evening. Also, it should be noted that advisors are ultimately responsible for the safety and welfare of their students throughout the convention including enforcement of the
Code of Conduct. Violations of the Code of Conduct must be reported to the District Administrator immediately.

Advisors, again, YOU are responsible for the individuals from YOUR club.

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Dress Code and Key Clubber Packing List
Divisional spirit attire (one outfit for Friday General Session)
Dress up to celebrate your divisional spirit as much as you want! Please, no glitter or noisemakers.

Business attire (one outfit for Caucusing; two outfits for delegates)

Attire for Caucusing and House of Delegates will be strictly enforced! Business attire includes blazers,
slacks, blouses, dress code appropriate business skirts, etc.

Paper and a Writing Utensil

Used to take notes during Caucusing and during workshops.

Casual pants (Saturday Forums)

Please bring one pair without holes or tears to wear with your provided convention t-shirt.

Underclothes
Shoes
Semi-formal attire (Saturday evenings General Session and Governors Ball)
Please bring one appropriate semi-formal outfit for the dance.

Casual attire (Sunday morning)

Bring one comfortable outfit to wear on your way home.

Toiletries
Pajamas (Friday and Saturday Night)

Optional Items: Spending money (to donate to The Eliminate Project during miracle minutes, buy themed
charity ribbons to support District and International Projects, buy raffle tickets to dance with a District Board
member, buy food, etc.)

Meal Overview

Friday evening, a grab and go dinner will be provided.

Saturday morning, breakfast will not be provided, but there will be options available for
purchase at the Washington State Convention Center.
Saturday lunch will be provided in the form of a boxed lunch.
Saturday evening, dinner will not be provided, please plan accordingly.
Sunday morning, breakfast will not be provided.

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Key Points:

Registration is due February 1, 2016.

Pricing is as follows
Registration: $155 per person
Housing: Quad-$110; Triple-$146.67; Double- $220; Single- $440
Registration postmarked after February 1, 2016 will be considered late and will be subject to a late fee of $100 per attendee.
Full payment must accompany your clubs registration, or it will be returned. You cannot
attend District Convention without submitting proper payment.
Registration begins Friday at 3 PM and will continue until 6 PM. Sergeant-at-Arms will direct you when you arrive at the hotel.
If your club is from Alaska or Canada, it is strongly advised that you send your registration
in 2 weeks early to ensure your forms will arrive on time.

Instructions:

Complete the online registration at www.registermychapter.com/keyclub/PNW

Step by step help for the online system is provided in pages 8-21
Complete medical authorization forms
One per attendee, including adults
Please ensure completeness otherwise processing will be delayed
Have each attendee review and sign the Code of Conduct
Include payment
The payment amount is shown on the invoice generated by the online system.
Payment options: credit card, check, or purchase order
Credit card: fill out the credit card information section on the Registration
Summary Form
Check: make checks payable to PNW Key Club Convention
Purchase Order: An invoice will automatically be generated by the online system when you submit your registration information. This invoice should be submitted immediately to the appropriate school official for payment.
Mail the following documents to the address included on your invoice:
Registration Summary Form
Medical authorization forms
Code of conduct forms
Payment
Annual Achievement Report (found on pages 3-6 of Section C)
You will receive a confirmation email from the online system when your registration is
successfully submitted.
A payment receipt will be emailed to you upon receiving payment.
Please direct all registration questions to keyclubdcon@gmail.com
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District Convention 2016

1) Go to the registration website.

Go to this web address: http://www.registermychapter.com/keyclub/PNW

Or click the Online Registration Link on the PNW Key Club District Website.

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2) Login by using your Club ID as both the username and password.

If you dont remember your Club ID you can find it listed in the Membership Update Center.
Club IDs for clubs in PNW are a capital H followed by 5 numbers (i.e. H12345).

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3) Fill in the Advisor and School contact information.

Please list the Advisor who will be responsible for your club at District Convention. If the faculty advisor is not attending, please list the Kiwanis advisor, or lead chaperone here.
The School contact information on file with the District will automatically populate. This can be edited if any of the information is incorrect.
Select your Division in the Area (region or district) field.
Note that Arrival Date should be 03/18/2016, departure should be 03/20/2016.
Select your payment method.
Click Save to advance to the next step.

Note: If you select Credit Card - Please fill out the credit card information on the form provided in Section A
of the Call to Convention (page 24) and mail in with your Code of Conduct and Medical Authorization Forms.

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4) Add attendees by clicking Add New Name

Enter the attendees information and click Save

Repeat these steps for each attendee

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5) For each attendee, click on Meals/Ribbons to select the meal type and ribbons.

Select one meal type (Regular or Vegetarian)

Select any ribbons for this attendee then click Save
Repeat these selections for each attendee

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6) Click Housing to advance to the rooming requests for the attendees listed.

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7) Select a Hotel.

The Sheraton is the primary Hotel.

Rooms are available on a first come first serve basis. If the system notifies you that rooms are not
available at the Sheraton, you may select from one of the overflow hotels.

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8) Select a room type for the attendees you wish to assign.

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District Convention 2016

9) Select Room #1 to begin assigning attendees to your first room

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10) Select all of the attendees that will be in the current room by clicking the check box
next to their name.

Repeat steps 8-10 as needed until all of your attendees have been assigned a room**++
**If you plan to have any attendees share a room with members of another club, do NOT
assign them to a room yet. Follow the instructions in Step 10a on the next page.
++If you have a Lieutenant Governor or other District Board member in your club, please
register them with your club but do NOT assign them to a room. The District will assign them
to a room after they have registered with their home club.
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10a) Instructions for sharing rooms with attendees from other clubs.
**If you plan to have any attendees share a room with members of another club, do NOT
assign them to a room yet. You may save your registration without submitting. Follow these
steps:
1. Talk to the advisor of the other club and decide which club will register the shared room. The
price of the room will automatically be split up between the two clubs based on how many
members from each club are in the room.
2. If the other club is registering the room, leave your attendees unassigned. You will be able to
complete your registration after the other club adds them to their room.
3. If you are registering the shared room, add your attendees to the room with the process
described in steps 8-10.
4. Then click Add from another chapter to find the attendees from another club.
5. Select their School from the drop down list.
6. Select the names of the students from the other club. If the names do not show up in the drop
down list, contact the other advisor and make sure they are not assigned to a room.

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11) Review your rooming assignments.

When complete, click Submit Hotel Reservation

You will be returned to a registration summary page.
It should indicate that Your housing reservation has been submitted.
The total Balance due for registration and housing will be listed.

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12) Submitting your Registration.

Make sure your payment method is selected.

Read the advisor agreement and check the box.
Click Submit to finalize your registration.

Note: If you select Credit Card - Please fill out the credit card information on the Registration Summary Form
and mail in with your Code of Conduct and Medical Authorization Forms.

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13) After submitting registration you will see an invoice.

You may print as many copies as you need from this screen.

Mail your payment and medical authorization forms to:

PNW Key Club Convention
c/o Mike Wallis
WWC Business Solutions
1024 Marine Drive
Astoria, OR 97103
Payment, Medical Authorization Forms, Registration Summary Form, Annual Achievement Report (found on
pages 3-6 of Section C), and Code of Conduct Forms must be postmarked by February 1, 2016

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Authorization Form
Authorization to attend Event and Emergency Medical Treatment
Please type or print all information. This form is required for all Key Club members attending designated Key Club International events
or activities. The parent, legal guardian or person in loco parentis for the member must complete this form. By signing this document, I
acknowledge that I am aware that photos taken of me during the event weekend may be published in magazines, Web or other
marketing and promotional materials.

Member Information

______________________________________
First Name

M.I.

Last Name

______________________________________
Street Address

______________________________________
City

State/Province

______________________________________
ZIP/Postal Code
Sex (circle one) F
Birth date

Nation
M

Height___________ Weight__________

Month____________ Day__________ Year_________

Chaperone
Who is the designated chaperone responsible for this
Key Club Member?

________________________________
Relationship to Member
Note: An adult chaperone for Key Club shall be a Kiwanis member,
faculty member, parent, legal guardian or person who is in in loco
parentis, over the age of 21, approved by the school and registered
with and accompanying the Key Club member at the event or activity.
All non-Key Club members over the age of 18 attending the Key Club
International convention must have a background check that is conducted by Kiwanis International.

Emergency Information
In case of emergency, please contact_____________________________
Phone (______) _______________________________________________

Cell Phone (______)_______________________________________

Alternate contact_________________________________________________
Phone (______) _______________________________________________

Relationship to member __________________________

Relationship to member __________________________

Cell Phone (______)_______________________________________

Medical Information
Health insurance company_________________________________________ Policy number________________________________________
Group name on insurance coverage _____________________________________________________________________________________
Telephone number or other contact information shown on insurance card__________________________________________________
Will you Key Club member be taking any prescription medication or over-the-counter drugs of any type?____________________
If yes, please explain _____________________________________________________________________________________________________
Has he/she ever been or currently being treated for (circle Yes or No)?
Nervousness?

Yes No

Rheumatic fever?

Yes No

Asthma?

Yes No

Convulsion or epilepsy?

Yes No

Cancer or tumors?

Yes No

Diabetes?

Yes No

Heart condition?

Yes No

Headaches?

Yes No

Allergies to medication?

Yes No

High blood pressure?

Yes No

Fainting spells?

Yes No

List any allergies or other medical conditions of which we need to be aware_________________________________________________

__________________________________________________________________________________________________________________________
I am the parent or legal guardian for the above-named Key Club member, and give my permission for him/her to attend the convention, conference and/or other event(s) sponsored by Key Club International. I also have read and understand the Code of Conduct shown on the
reverse side, and I understand that a violation of certain provisions of these rules may result in the dismissal of my Key Club member from the
event. I hereby certify that the information provided above is correct.
In the case of medical emergency, I understand that every effort will be made to contact the emergency contacts listed above. In the event
those persons cannot be reached or time does not permit, I hereby give permission to a licensed physician or other licensed medical provider,
to provide proper treatment, including but not limited to hospitalization, injection, anesthesia and/or surgery, for the above-named Key Club
member. On behalf of myself and my ward/minor, I/we hereby RELEASE, WAIVE AND FOREVER DISCHARGE Key Club International and its officers, directors, employees, parents and subsidiaries, agents, from any and all claims, liabilities, causes of actions, damages, demands, judgments, executions, liens and costs whatsoever, in law or equity, including, without limitation, liability for death or bodily injuries to any person or
damage to any property resulting from any (i) claims made against medical providers of emergency services under this authorization, or (ii)
against Key Club International for obtaining medical emergency services for said Key Club member pursuant to this authorization.

Parent or guardian____________________________________ Signature______________________________________ Date_______________

District Convention 2016

Convention Rules

District and International dues for the current year (2015-2016) must be paid for each Key Clubber attending District Convention by December 1, 2015.
Please be sure that an Annual Achievement Report Form has been mailed in for your club by February 1,
2016. This form will be included later in this packet.
There must be one adult for every ten Key Clubbers in attendance.
Only advisors or chaperones may pick up their clubs registration materials and room keys upon arrival.
Every club member in attendance shall respect the authority of the Sergeant-at-Arms.
A curfew of 12:00 midnight Friday and 12:30 AM Sunday will be observed and is expected to be enforced
by the clubs chaperones.
Key Clubbers are expected to be mindful of their noise levels as there are other guests staying in the hotel.
Key Clubbers will not leave the hotel or the Convention Center without a chaperone.
No intoxicants or drugs of any kind will be in possession of anyone attending convention; nor will smoking
be permitted.
Property shall not be defaced or destroyed and furniture will remain inside the hotel rooms. Any damage
will be the responsibility of the person(s) occupying that room.
Any action unbecoming of a Key Clubber will not be allowed.
The pool and exercise areas are off limits during Convention.
No Key Clubber may change room assignments without the express consent of the District Administrator.
Key Clubbers of opposite genders shall not be allowed in the same room, except when properly chaperoned by a Faculty advisor, Kiwanis advisor, parent, and/or administrator.
Convention name badges and wrist bands must be worn in a visible position at all times.
Violation(s) of any of the Convention Rules by any individual member of a Key Club will result in that member being sent home prior to the Conventions close, or other disciplinary actions as deemed appropriate.
Anyone dismissed from Convention will arrange transportation at their own expense and parents as well as
appropriate school officials will be notified of the incident that led to the dismissal.

Key Clubbers are known for acting as responsible young adults. The rules outlined here are
minimum standards of conduct. Violations of the rules will be handled with the best interest of
Key Club in mind.
I have read, understand, and agree to abide by the Convention Rules.
Printed Name of Key Clubber : ________________________________________________________________

Key Clubber Signature: ___________________________________________ Date: ______________________

Parent/Guardian Signature: ______________________________________ Date: ______________________

Advisor Signature: _______________________________________________ Date: ______________________

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District Convention 2016

Key Club of ______________________________ High School

Division ________

Quad Registration ($155) and Housing ($110)

________

$265.00 per person

Triple Registration ($155) and Housing ($146.67)

________

$301.67 per person

Double Registration ($155) and Housing ($220)

________

$375.00 per person

Single Registration ($155) and Housing($440)

________

$595.00 per person

Late Fee (after February 1st, 2016)

________

$ 100.00 each

Payment by:

[ ] Check

[ ] Credit Card

[ ] Purchase Order

TOTAL
==========

NOTE: REGISTRATION AND HOUSING INCLUDE ROOMS FOR FRIDAY AND SATURDAY NIGHT AND MEALS
FOR FRIDAY DINNER AND SATURDAY LUNCH.

CREDIT CARD INFORMATION ONLY

[ ] VISA [ ] MASTERCARD
Cardholders Name

Expiration Date ____/____ Billing Zip Code _________ TOTAL ____________

_______________________________________________

Card Number _______ - _______ - _______ - _______

Date ______________

Signature ____________________________________

CVV Code: _____________

Billing Address: _____________________________________________________________________________

Disclaimer: Clubs are responsible for filling their own rooms. We encourage that clubs coordinate with
nearby schools in their respective divisions to fill each room to quad occupancy if desired.
THIS SUMMARY FORM AND FULL PAYMENT
MUST BE POSTMARKED BY
FEBRUARY 1, 2016
Please make checks payable to PNW Key Club Convention

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District Convention 2016

Please make sure complete the following:
Online registration at www.registermychapter/KeyClub/PNW
Mail to Mike Wallis
Code of Conduct

One per student

Medical Authorization Form

One per attendee (this includes both Key Clubbers and adult chaperones)

Registration Summary

One per club

Payment in total
Annual Achievement Report (found on pages 3-6 of Section C)
Service Fair Registration (optional)
Bring to Convention
Club Delegate Registration (turn in on Friday during registration at the Credentials Desk)

Make checks payable to PNW KEY CLUB CONVENTION (USD)

Mail to:

PNW Key Club Convention

c/o Mike Wallis
WWC Business Solutions
1024 Marine Drive
Astoria, OR 97103

MUST BE POSTMARKED BY February 1, 2016

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District Convention 2016

WHAT?
The House of Delegates is the business session where District Executive officers are elected, and
amendments to District Bylaws and proposed resolutions are considered and acted upon.

WHEN?
11:00 am on Saturday, March 19, 2016

WHO?
Each club in good standing is entitled to two (2) delegates. It is highly recommended that these be
the club president and vice president. Alternates should be chosen for each delegate. Each delegate
shall be entitled to cast one vote. The alternate may cast the vote if the elected delegate is not in attendance at the convention. There shall be no voting by proxy. No club delinquent in the payment of
International or District dues shall be considered in good standing.
Delegates should be selected by each club prior to convention, and the Club Delegate form included in this registration packet must be filled out and turned in at District Convention at the
Credentials Desk. Delegates must check in at the Credentials Desk during hours of operation: Friday
during registration and Saturday morning. Upon check-in, each delegate will receive a delegate ribbon for his/her name badge which acts as a delegate pass, and a candidates booklet. To be admitted to this session as a voting member, each delegate must have their name badge ribbon.
District Bylaws provide that each current Lieutenant Governor, as well as the Executive Offices of
Governor, Secretary, Treasurer, and Bulletin Editor, shall serve as Delegates-At-Large.
Non-voting Key Clubbers permitted in the "Delegate" portion of the House include any
International Officers and Liaisons.
Limited seating for non-delegates and others interested will be available in a separate section of the
House.
As a delegate, you are personally responsible for being in the House of Delegates on time. This means
being seated no less than ten minutes prior to the scheduled convening of this session.
You should review carefully any information provided to you pertaining to the business to be conducted.
"Robert's Rules of Order, Newly Revised" will be the official procedure followed. These rules must be
adhered to at all times during the House of Delegates session.
NOTE: PLEASE BRING A PEN WITH YOU TO THE HOUSE OF DELEGATES SESSION TO PROPERLY MARK YOUR BALLOT.

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Each Key Club can select two delegates to represent their club at the House of Delegates at
the 67th Annual Key Club Pacific Northwest District Convention. Delegates will elect the 20162017 leaders of the Pacific Northwest District and vote on any proposed amendments to the
Bylaws. To register delegates from your club, this form must be completed.
This certificate of election must be completed and presented to the Credentials Desk at District
Convention. This certifies that the persons named have been selected as delegates by the
club. At the convention, there will be a credentials registration area where each delegate will
be issued a delegate ribbon and pass, which allows entry into the House of Delegates. Once in
the House, each delegate will trade his/her delegate pass for an official ballot.
THIS IS TO CERTIFY that the following members of the KEY CLUB of ____________________________
from ____________________(division), of __________________ (city/state/province) are the duly
elected delegates and alternates of this club to the 67th Annual Key Club Pacific Northwest
District Convention.
Delegates
1. _____________________________________
2. _____________________________________

Club Secretary Signature: ____________________________________________________

Date: ________________

Please bring this certificate with you to Convention! Do not mail this form in. This change is to
provide flexibility in delegate changes until the day of convention.

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What is the Service Fair?
The Service Fair is an optional-participation event where clubs and organizations in the Pacific
Northwest District gather together at District Convention to showcase their unique service projects.
How do you participate?
To participate, your club or organization needs to completely fill out the registration form. If your club
would like to submit more than one service project, fill out additional forms as needed.
Representatives are people who will setup, cleanup, and take care of your clubs booth during
the Service Fair. Please note: Every club and organization is required to bring a self-standing presentation board and handouts related to the project (i.e. brochure, flyer) that will be taken by people
during the Service Fair.
What kind of information do we need for our standing presentation and handout?
All information necessary to outline your project or organization is recommended: name, club, division, title of project, when and where it happened, what your club did, pictures, etc. Make it colorful
and appealing. Handouts should outline your service project or organization in a nutshell. Pictures
are not necessary.
Are we allowed to use another medium in addition to the presentation board to exhibit our project?
Yes. In addition to the presentation board, you may bring a laptop to show anything that outlines
your project. Please indicate on the registration sheet if you are doing so, so we can properly prepare.
What will be provided at Service Fair?
Only a table and chairs will be provided. All other supplies are at the expense of the club or organization. If anything else is needed (power outlet, etc.), include your request on your registration form.
Please recap everything in a nutshell of what we are supposed to do
Mail a completed Service Fair Registration Form AND Handout to the address on the registration
sheet. After submitting everything, clubs create the presentation board and copies of handouts.
Then bring these items to the Service Fair at District Convention.
If you have any questions about Service Fair, please contact:

Convention Chair
Ryan Miura
pnwconventionchair@gmail.com

or

Service Fair Committee Chair

Leah Maly
pnwservicefair2016@gmail.com

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Pacific Northwest District
67th Annual Key Club Convention
High School or Organization : _________________________

Division (if applicable) : _______

Contact Person : _____________________________________

Contact Email : ______________________________________
Contact Phone Number : (______) _______ - _________
Brief Explanation : ______________________________________________________________________
________________________________________________________________________________________
Check Appropriate Box Below:

Personal Club Project

Project Involving Service Partners or Major Emphasis
Service Organization
Other
Check All That Apply:

Power Required for Booth

Tables Needed: Number of Tables : ______
POSITION

FULL NAME

* : Clubs only

PHONE NUMBER

E-MAIL ADDRESS

President*
Faculty Advisor*
Representative
Representative
Representative

_______________________________

________________________________

Club President*

Faculty Advisor or Kiwanis Advisor*

PNW Key Club Convention
c/o Mike Wallis
WWC Business Solutions
1024 Marine Drive
Astoria, OR 97103

MUST BE POSTMARKED BY February 1, 2016

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