Registration deadline is March 14,
2010, 11:59pm CST.
After that date a $45 late fee will be charged. NO EXCEPTIONS! |
PERSONAL INFORMATION: |
| The way you enter your name is how it will be printed on your name tag. |
| First
Name: |
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| Last
Name: |
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| School: |
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| Company: |
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| Address: |
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| City: |
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| State: |
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| Zip: |
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| Cell Phone: |
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| Email: |
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MEMBERSHIP INFORMATION: |
Membership:
Check all that apply |
Pi Sigma Epsilon
Mu Kappa Tau
PSE Life Member |
Membership Type: (Press
Control + Click to Select all that apply) |
|
| Year in School: |
Collegian Members |
| Expected Graduation Date: |
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| PSE Officer
Position: |
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| Job Title: |
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| Employer: |
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How many National Conventions
have you attended: |
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Date you will be arriving
for convention: |
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Date you will be leaving
convention: |
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SPECIAL REQUESTS: |
Vegetarian
Meals: |
Yes No |
I
am planning to compete in the Pro-Am Sell-a-Thon |
You must register
online to participate |
| I am planning to attend
the Certified Chapter Officer Program |
Yes No
Position to be trained
|
| I am a diamond level
CCO Member |
Yes No |
EMERGENCY INFORMATION: Must be completed
|
| Emergency
Contact: |
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| Emergency
Contact Phone: |
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| Medical
Condition: |
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List any medications
you are allergic to: |
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PAYMENT INFORMATION: |
| Credit Card: |
Visa
Mastercard
American Express |
| Credit Card
Number: |
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| Name
on Card |
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| Card
Expiration: |
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REGISTRATION FEES:
|
$230 - PSE/MKT members in good
standing whose registrations are paid on-site,
faxed, or post-marked by March 14, 2010, 11:59pm CST. |
|
$275 - PSE/MKT members in good
standing whose registrations are paid on-site,
faxed, or post-marked after March 14, 2010. |
| |
$345 - Guest registration fee
for guest registrations paid on-site or faxed
or post-marked by March 14, 2010, 11:59pm CST. |
| |
$390 - Guest registration fee
for guest registrations paid on-site or faxed
or post-marked after March 14, 2010. |
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$45- Saturday April 10, 2010
For those attending the Banquet Only. |
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$65 - Annual National Dues
for members not currently in good standing. |
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$5 - PSE Flip-Flops |
| |
Ladies' (6 - 8)
Men's Medium (9 - 10)
Men's Large (11 - 12)
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