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Registration for Annual Convention

Today's date (enter date in DD/MM/YYYY format): *

Registration for (chapter name): *

Registration for (institution name): *

Name of contact person: *

Email address of contact person: *

Phone number of contact person

Address, for receipts, as necessary

Names of delegates attending and preferred pronouns *

Please separate each name with a comma.

TOTAL number of delegates attending, including chapter advisor: *

Approximate arrival date and time: *

Arrival/Departure Location

Shuttle Service from/to Airport Shuttle Service from/to Airport

Approximate departure date and time: *

Dietary restrictions

TOTAL @ either: $60.00 each by check; $65 by PayPal; $75 after February 18. *

NB: Registration is free for one faculty sponsor, provided registration is completed by February 18.
The fee includes a PayPal surcharge.

After submitting this form, proceed to the Eta Sigma Phi store (the "Regalia" page) and look for "Annual Convention Registration" to make your payment.

Website/URL

If you are human, leave this field blank.