Omega Psi Phi Fraternity - Fifth District

The following registration fees apply:
Before Feb. 1, 2010	After Feb. 1, 2010	Onsite Registration Fees
Delegates & Non Delegates $175.00	Delegates & Non Delegates $200.00	Graduate Delegates & Non-Del. $225.00
Undergrad Delegates & Non Del. $125.00	Undergrad Delegates & Non Del. $140.00	Undergrad Delegates & Non Del. $165.00

HOST CHAPTER: Kappa Iota, Chattanooga, TN
HOTEL: Chattanooga Marriott at the Convention Center -Two Carter Plaza
Chattanooga, TN 37402. 1-423-756-0002
Chattanooga Marriott at the Convention Center is located in the heart of downtown, convenient to offices, interstates, attractions, dining and nightlife. Wireless high speed internet access is available in all guest rooms and meeting space.
THEME: Everything Rises and Falls on Leadership
Online Pre-Registration Form

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

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

* Delegate must also complete and mail
Form 36 (CREDENTIALS FOR CHAPTER DELEGATES) to:
Brother Sullivan R. Ruff, Jr. (District Marshal)
home (423) 894-4419 or cell (423) 645-4420 e-mail sullivanruff@bellsouth.net
7835 Opal Drive, Chattanooga, TN 37416

MUST BE POSTMARKED BY January 31, 2010. See Forms page to download Form 36 and other forms

* Voting Status: (Select One)
Graduate Delegate ($200)	Undergraduate Delegate ($140)

Qty	Activity	Amount
1	Basic Pre-registration fee (both Graduate & Undergraduate) includes: (Souvenir Portfolio, Souvenir Booklet, Admission to Undergraduate Luncheon, Life Membership Breakfast, March Down Competition, founders Banquet and Founders Ball/Dance)	$
	Extra Founders Banquet and Dance Ticket @ $50 each	$
	MarchDown Competition Tickets @ $15 each	$
	Quette Registration @ $100 each - Before Feb. 1, 2010	$

Sub Total $

Processing Fee $

GRAND TOTAL $

Click the PayPal button below to complete your secure Registration.

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