Workshop Registration

Full Name: *

Preferred Name: *

Your preferred name will be printed on your name badge.

Current Chapter Office:

If applicable, please indicate the chapter office in which you are currently serving.

Chapter: *

If Other Please Specify:

Year of Initiation: *

E-Mail Address:

Telephone Number: *

Housing Arrangements: *

Please specify where you will be staying for Workshop. For hotels, please list the hotel name.

When will you be arriving at Workshop: *

Will you be attending the banquet?: *

Yes

Dietary Restrictions:

Please specify any special dietary needs you may have.

National News