2. Fill out either the Credit Card Authorization or the Check Payment.

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2 REGISTRATION INSTRUCTIONS 1. Print the registration package and identify the forms you will need. 2. Fill out either the Credit Card Authorization or the Check Payment. 3. Make check out to CLUB MED for $ or if you are requesting additional nights add $ per person per night. Single occupancy rate is $ with additional nights at $ Make registration check out to Blue Knights FL-X for $25.00 per person. 5. Place guest(s) names on the payment form. 6. Send ALL paperwork to Blue Knights FL-X. at the address on the form. DO NOT SEND FORMS DIRECTLY TO CLUB MED Your payment includes the following in addition to other Club Med activities: Accommodations as per the contracted room categories Expert lessons and top-of-the-line sports equipment Award-winning Children s Clubs for ages 4 and up (programs for ages 3 and under available for an additional cost) Due to space limitations, this service will be arranged on first come, first served basis Gourmet dining experiences throughout the day Full open bar with premium* alcoholic and non-alcoholic beverages Daily entertainment, including but not limited to; local bands, circus shows, and performances showcasing the talents of our Gracious Organizers ( G.O.'s ) Dedicated Group coordinators to attend to your group needs. All Taxes and Gratuities included (no hidden charges and no surprises) *Additional charge may apply for select brands at select resorts.

3 CANCELLATION CHART The Client acknowledges that the detriment to Club Med upon cancellation of any spaces under this agreement is not subject to exact measure; therefore, Club Med is entitled to retain the cancellation charges set forth herein as liquidated damages. Club Med reserves the right to cancel this agreement in writing up to 150 days prior to the scheduled operation of the Travel Program Dates, with full refund, for any reason whatsoever. Club Med shall have no obligation whatsoever to sell such unused land accommodations or transportation and Client shall remain liable and responsible for the full amount of the Total Group Program price. Cancellation by the Client will be subject to the following penalties: *CANCELLATIONS MUST BE MADE IN WRITING*

4 Blue Knights International Motorcycle Club Southern Regional Conference - Fall September 14,15,16, Hosted by Florida-X Join us at the All Inclusive Club Med-Sandpiper in Port Saint Lucie, Florida SPACE IS LIMITED REGISTRATION FORM BOOK EARLY NAME OF MEMBER: BK MEMBER ID#: GUEST/SPOUSE NAME#: CHILD #1 NAME/AGE: CHILD #2 NAME/AGE: MAILING ADDRESS: CITY: STATE: ZIP: ADDRESS: CONTACT NUMBER: STATE/CHAPTER/COUNTRY: SHIRT SIZE: S M LG XL XXL XXXL CONFERENCE REGISTRATION Please enclose a check for $25.00per person payable to: Blue Knights Florida-X. SINGLE OCCUPANCY All Inclusive Club Med September 14,15,16, 2017 Please enclose a check payable to Club Med for the FULL amount of *$ and mail to: Blue Knights Florida-X. *Additional nights are: $ per person *Kids under 15 are $ (additional nights are $55.00) DOUBLE OCCUPANCY All Inclusive Club Med September 14,15,16, 2017 Please enclose a check payable to Club Med for the FULL amount of *$ and mail to: Blue Knights Florida-X. *Additional nights are: $ per person *Kids under 15 are $ (additional nights are $55.00) *NOTE: REFUNDS ARE SUBJECT TO CLUB MED RULES. PRICE INCLUDES TRAVEL INSURANCE, TAX & GRATUITY. ACTIVE DUTY LEO S WILL RECEIVE 100% REFUND IF UNABLE TO ATTEND DUE TO EMERGENCY / NEEDS OF YOUR DEPARTMENT. SEE CANCELLATION CHART. DIRECTIONS FOR CREDIT CARD PAYMENTS - FOR CLUB MED ONLY Please download CLUB MED AUTHORIZATION FORM. And send completed form to: Blue Knights Florida-X. *NOTE: REFUNDS ARE SUBJECT TO CLUB MED RULES. PRICE INCLUDES TRAVEL INSURANCE, TAX & GRATUITY. ACTIVE DUTY LEO S WILL RECEIVE 100% REFUND IF UNABLE TO ATTEND DUE TO EMERGENCY / NEEDS OF YOUR DEPARTMENT. SEE CANCELLATION CHART. or FAX completed form to: REFUNDS ARE SUBJECT TO CLUB MED RULES. PRICE INCLUDES TRAVEL INSURANCE, TAX & GRATUITY. ACTIVE DUTY LEO S WILL RECEIVE 100% REFUND IF UNABLE TO ATTEND DUE TO EMERGENCY / NEEDS OF YOUR DEPARTMENT. SEE CANCELLATION CHART BELOW SPACE IS LIMITED BOOK EARLY BOOK BY APRIL 1 st TO RECEIVE 1 ENTRY FOR A CHANCE TO WIN A CLUB MED VACATION

5 Credit Card Authorization Form 6505 Blue Lagoon Drive #225 Miami, FL, Attn: Accounting Department Fax: CLUB MED GROUP COORDINATOR: GROUP NAME: BLUE KNIGHTS FL X, INC. GROUP LEADER: Steven Confino, Bob Newman, Ed Forte Address: Blue Knights Fl-X Inc., Port St. Lucie, FL Phone: I hereby authorize Club Med Sales to charge my (Name of Cardholder) (Credit Card Type) (Credit Card Number) / Transaction number (Exp. Date) (CCV 3 Digit number/4 digit for Amex) In the amount of $ for vacation/air payment for myself and/or: PLEASE INDICATE TYPE OF BED: 1 BED KING 2 BED DOUBLE (Full name(s) of guest(s) if other than the card holder) Check In: / /2017 Traveling to our village SANDPIPER BAY FLORIDA on the date of / /2017. Check Out: / /2017 Credit Card Holders Address: X (Authorized Signature) (Date) ******Cancellations must be made in writing and are subject to contract penalty fees****** **TO RESPECT THE SECURITY AND PRIVACY OF YOUR CREDIT CARD, PLEASE PUT ANY ADDITIONAL INFORMATION ON THE FOLLOWING PAGE **

6 CHECK PAYMENT 6505 Blue Lagoon Drive #225 Miami, FL, Attn: Accounting Department Fax: Transaction number CLUB MED GROUP COORDINATOR: GROUP NAME: BLUE KNIGHTS FL X, INC. GROUP LEADER: Steven Confino, Bob Newman, Ed Forte Address: Blue Knights Fl-X Inc., Port St. Lucie, FL Phone: NAME OF VILLAGE: SANDPIPER BAY, FLORIDA ARRIVAL DATE: DEPARTURE DATE: TOTAL NIGHTS: MEMBER NAME: GUEST NAME: PAID BY CHECK: No. CHECK IN DATE: / /2017 CHECK OUT DATE: / /2017 PLEASE INDICATE TYPE OF BED: 1 BED KING 2 BED DOUBLE Additional Info: