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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.

T-shirt sizes (include amounts of each size) for all delegates including chapter advisor:

TOTAL number of delegates attending, including chapter advisor: *

Approximate arrival date and time: *

Approximate departure date and time: *

TOTAL @ either: $90.00 each by check; $95 by PayPal; $100 after March 6 *

NB: Registration is free for one faculty sponsor, provided registration is completed by March 6.
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.

If you are human, leave this field blank.