South Carolina Division United Daughters of the Confederacy®

                   114th Annual Division Convention, Town & Country Inn and Convention Center
                                                 2008 Savannah Hwy, Charleston SC 29407
                                            (843) 571-1000 local or (800) 334-6660 toll free
                                                           September 23 – 25, 2010
                                                                  Registration Form

MUST BE RECEIVED NO LATER THAN AUGUST 20, 2010

Registration Fee:  $5.00    Make Check Payable to:  SC Division Treasurer and mail form and check to:
Kelly Davis
2561 Old Calhoun Falls Road, Abbeville, SC 29620-4705
(864) 446-8470  Email:  dixiesland@hotmail.com

South Carolina Bylaws:  Article XXII Section 3. “All Chapters in the Division properly chartered are entitled to
representation in the Convention of the Division. The President of the Chapter shall be First Delegate to all
Conventions. Each Chapter shall be entitled in all conventions of the United Daughters of the Confederacy to
one vote for the first seven members and one vote for each additional twenty (20) members who at said
convention shall have paid per capita 30 days prior to the Annual Convention, are in good standing and have
been registered with the Division Registrar. A Chapter may have twice as many Alternates as Delegates.”

Please Check and Complete ALL Applicable Boxes Below.  Print clearly.

Name: _____________________________________________________________________________
Print name as it is to appear in the Annual Division Minutes Book

Address: ___________________________________________________________________________

City: ______________________________________ State: ____________ Zip+4: ________________

Phone: Home (_____) _________________________Office  (____)___________________________

Fax: _(_____)_______________________ E-Mail: ___________________________________________

Chapter Name: ______________________________________________________________________

Chapter No. ________________________ Chapter City: ____________________________________

Please Check and Complete ALL Applicable Boxes Below

o    Division Officer – Division Office Held: _______________________________________________
o   Appointive Officer – Appointive Office Held: ___________________________________________
o   Ex Division President                                o    Honorary Division President
o    Division Committee Chairman – Standing and Special: Committee Name: _____________________
o    Ex President General                                o    Honorary President General
o    District Director:   Incoming / Outgoing    Name of District: _______________________________
o    Chapter President:  Incoming / Outgoing  Chapter Name and No.: __________________________
o    Chapter Officer – Chapter Office Held: ______________________________________________
o    Chapter Delegate                                o    Chapter Alternate
o    Real Daughter  o Granddaughter  o Great-Granddaughter  o Great-Great-Granddaughter
o    UDC Member                                o    CofC Member
o    CofC Division Officer – CofC Office Held: _____________________________________________
o    CofC General Officer – CofC Office Held: _____________________________________________
o    Guest – Organization:  __________________________________________________________