Omega Phi Alpha

Convention 2006

Hartford, CT July 19-23, 2006

Registration Form

PARTICIPANT INFORMATION 

Please provide the following information about you for registration.  Use your SUMMER contact information so that we can reach you during summer months if need be.

First name  

Last Name

Chapter
Maiden Name

Activation

        Year

Address
City Delegate Yes  No
State    

Zip

Status
Phone
E-mail
Guests coming with you:

TRAVEL INFORMATION

Flight Information
Arrival Information Departure Information
Date  Date
Airline Airline
Flight # Flight #
Arrival Time Departure Time
Driving  Information
Arrival Date: 
Arrival Time:

LODGING INFORMATION

Lodging will be provided by the Hilton Hartford Hotel, 315 Trumbull St, Hartford, CT, 06103. Phone: (860) 728-5151  Fax: (860) 240-7247

 
DATE Single  Double Triple Quad
$110.88/night $55.44/night $36.96/night $27.72/night
Wednesday, 7/19/05

Thursday, 7/20/05
Friday, 7/21/05
Saturday, 7/22/05
 Total Lodging $  

Preferences: 

 smoking non-smoking 
Special needs Roommate Request:
***If a roommate preference is not noted, you may be placed in a room with any attendee of convention.  “Pot luck” roommates are available only on a first come, first-served basis.  Therefore, a double, triple, or quad room rate is only available if there are actually two, three, or four people staying in the room. ***

Please contact convention@omegaphialpha.org with any questions or for more information.
OTHER FEES
Fee Description Cost less savings account, OPA awards, etc.. Your Cost
Registration Fee (all week) $50.00

Registration Fee (daily)

Wed  Thur 

Fri     Sat

 $15.00
Registration Fee (late) $25.00
Closing Banquet 7/22/06 $50.00
T-shirt (small - XL) $12.00
T-shirt (2X or 3X) $14.00
Total Other Fees $
TOTAL FEES & PAYMENT INFORMATION
Total Lodging: $
Total Other Fees: $
Total DUE: $

Payment Options

Pay by Check 

Pay by PayPal 

If paying by check, print this page (before you click submit) and mail with payment made payable to Omega Phi Alpha to:

Myrinda Grantham

PO Box 5428

University, MS 38677

 

 After you click on submit, you will be directed to a page that will allow PayPal payments.  You are not registered until, at minimum, you submit the registration fee as deposit (either by sending a check or using the next PayPal page).  If you do NOT intend to pay by PayPal, please do not mark this option here.  You will need to know your total due to enter it on the next page.
Any additional comments, questions, or concerns

After you click on submit, you will be directed to a payment information page for payment deadlines, options, cancellation information, and an option for online payments by PayPal.

 

[ Back to Main Page ]