84th Annual ETA SIGMA PHI Convention
March 16-18, 2012
Columbia, Missouri

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 


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   

TOTAL @ $95.00 each :  $  Note: This amount includes a Paypal surcharge.

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.

 Click on "View Cart" button to pay via PayPal.

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
e-mail:  etasigmaphinational@gmail.com