English
Contact Information
Optional: Do you have a ClubRunner login?
User Name
:
User name is a required field.
Password
:
Password is a required field.
New and existing users: retrieve username and/or reset password
Your Information
First Name
:
Last Name
:
Name on Badge
:
Email
:
Primary Phone
:
Cell Phone
:
Work Phone (if applicable)
:
Are you a Cosmopolitan member?
:
-- -- Please Select -- --
Yes
No
Name of Club (if a member)
:
Do you require any special accommodations? If so, please explain
:
I am a Past International President
:
Yes
No
I am a Past International Spouse
:
Yes
No
I am on the CI Board (includes Governors)
:
Yes
No
I am a Governor-Elect
:
Yes
No
I am a Club President
:
Yes
No
I am a First Timer
:
Yes
No
I am a Delegate
:
Yes
No
I am on the CDF Board
:
Yes
No
I am on the CFC Board
:
Yes
No
I am a Northern Beacon
:
Yes
No
Select your current Beacon Status
:
-- -- Please Select -- --
Not yet a Beacon
I am a Beacon (100 - 1,000)
I am a Pearl Beacon (1,000 - 4,999)
I am an Emerald Beacon (5,000 - 9,999)
I am a Ruby Beacon (10,000 - 14,999)
I am a Sapphire Beacon (15,000 - 19,999)
I am an Amethyst Beacon (20,000 - 24,999)
I am a Diamond Beacon (25,000 +)
I consent to the collection, storage, and use of my information by Cosmopolitan International as described in this
Privacy Policy
. I understand that I may receive emails regarding this event and other relevant information, and can opt out at any time.
Required
Your Partner/Guest Information
First Name
:
Last Name
:
Name on Badge
:
Email
:
Primary Phone
:
Cell Phone
:
Work Phone (if applicable)
:
Are you a Cosmopolitan member?
:
-- -- Please Select -- --
Yes
No
Name of Club (if a member)
:
Do you require any special accommodations? If so, please explain
:
I am a Past International President
:
Yes
No
I am a Past International Spouse
:
Yes
No
I am on the CI Board (includes Governors)
:
Yes
No
I am a Governor-Elect
:
Yes
No
I am a Club President
:
Yes
No
I am a First Timer
:
Yes
No
I am a Delegate
:
Yes
No
I am on the CDF Board
:
Yes
No
I am on the CFC Board
:
Yes
No
I am a Northern Beacon
:
Yes
No
Select your current Beacon Status
:
-- -- Please Select -- --
Not yet a Beacon
I am a Beacon (100 - 1,000)
I am a Pearl Beacon (1,000 - 4,999)
I am an Emerald Beacon (5,000 - 9,999)
I am a Ruby Beacon (10,000 - 14,999)
I am a Sapphire Beacon (15,000 - 19,999)
I am an Amethyst Beacon (20,000 - 24,999)
I am a Diamond Beacon (25,000 +)
I consent to the collection, storage, and use of my information by Cosmopolitan International as described in this
Privacy Policy
. I understand that I may receive emails regarding this event and other relevant information, and can opt out at any time.
Select Options