60th Fifth District Meeting

The following registration fees apply:
Before Dec. 31, 2007	After Dec. 31, 2007	Onsite Registration Fees
Delegates & Non $175.00	Delegates & Non $200.00	Delegates & Non $225.00
Undergrad Delegates $110.00	Undergrad Delegates $110.00	Undergrad Delegates $125.00

Host Chapter: Epsilon Phi Chapter, Memphis, TN
THEME: Everything Rises and Falls on Leadership

Online Pre-Registration Form

(Note: A separate form must be completed for each Brother)

Control Number:
Current Chapter:		Chapter Location:
First Name:	MI:	Last Name:
Home Address:		City:
State:		Zip:
Home Phone:	() -	Work Phone:	() -
Quette Name:		Child(ren)'s Name:
Email:

* Delegate must also complete and mail
Form 36 (CREDENTIALS FOR CHAPTER DELEGATES) to:

Brother Brian Boulware
P O Box 1045
Collierville, TN 38027
Phone: (901) 606-5202
Email: b135omega@aol.com

MUST BE POSTMARKED BY March 19, 2008. See Forms page to download Form 36 and other forms

Voting Status: (Select One)
Chapter Delegate ($175)	Undergraduate Delegate ($110)

Qty	Activity	Amount
1	Basic Pre-registration fee includes (Souvenir Portfolio, Souvenir Booklet, Admission to Undergraduate Luncheon, Life Membership Luncheon, MarchDown Competition, Mixer Ticket, Founders Banquet and Founders Dance.)	$
	Extra Founders Banquet and Dance Ticket @ $40.00 each	$
	MarchDown Competition Tickets @ $20 each	$
	Extra Mixer Tickets @ $10 each	$
	Quette Registration @ $50 each	$

Sub Total $

Processing Fee $

GRAND TOTAL $

Click the PayPal button below to complete your secure Registration.

Note: If you don't already have a PayPal account, simply click on the Continue link to the left on the PayPal page under the "Don' have a PayPal Account?" question to complete your payment

Forms