On-Line Registration Form 2010 Convention

83rd Annual ETA SIGMA PHI Convention
March 25-27, 2011
Austin, Texas

Note: This On-Line Registration form can only be used if payment will be made on-line via Paypal.

Today's Date (Enter Date in DDMMYYYY format):

Registration for Chapter of (Name of Institution)

Name of Contact Person

Address

Street Address City

Zip Code State

Phone Number (with area code)

E-mail Address

Names of Delegates Attending

List Names Exactly As They Are to Appear on Delegate Badges.

1. 2.

3. 4.

5. 6.

7. 8.

9. 10.

11. 12.

13. 14.

15. 16.

17. 18.

19. 20.

TOTAL number of delegates attending

TOTAL number of Vegetarian delegates

N.B. There is no charge for one faculty chapter sponsor accompanying student delegates to the convention.

TOTAL @ $85.00 each : $ ($95 after March 15, 2011)

Clicking on "Submit" sends Registration Information to Eta Sigma Phi.
Do not do this until you have made your payment via Paypal. (See below.)
Please keep a copy of the completed registration form for your own records.

In order to PAY for these registrations, click on "Add to Cart," adjust Quantity to the correct number of Delegates, and then Proceed to Checkout.

NOTE: You are not officially registered until payment is made.

If you have any questions about this registration process, please contact:

Thomas J. Sienkewicz, Executive Secretary
Eta Sigma Phi
Department of Classics
Monmouth College
700 East Broadway
Monmouth, IL 61462
Phone: 309-457-2371
Fax: 815-346-2565
e-mail: toms@monm.edu