FDW17 Registration Form 1 .pdf

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Original filename: FDW17 Registration Form 1.pdf
Author: J. Jarrell

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Delta Phi Delta Dance Fraternity, Inc.
Founders' Day Weekend 2017
"A Dream 2 A Legacy"
January 13, 2017 - January 16, 2017
Official Registration Form

MEMBER'S PERSONAL INFORMATION
First Name:

Last Name:

T-Shirt Size:

Phone Number (day):

Email:

Chapter:

Small

Roommate Selection:
(To ensure roommate preferences are correcly matched, please consult with your roommate choices prior to submitting)

REGISTRATION FEE(S) (PLEASE MARK THE APPROPRIATE FEE(S))
Member With Lodging: $165

Members without Lodging: $90

Additional Guest With Lodging: $100

Additional Guest Non lodging: $65

(Members are responsible for their guests at all times during the event. Please note events included in Guest Registration.)

**NOTE**
There is NOT an on-site registration option for this event. The deadline for mailed in registration forms and payments is December 2, 2016. The deadline
for online registration forms and payments is December 9, 2016. No Registration Will Be Accepted After December 11, 2016 There Are No Exceptions!
Payment may be made earlier than required dates as well as in larger amounts for the Suggested Payment Plan.
Chapters, are encouraged to fund raise to assist with the costs for your members!

ACCEPTABLE PAYMENT METHODS
Online Payment Options:
Via Delta Phi Delta Website: Payments will include a $5 PayPal Convenience Fee (Assessed by PayPal)
Via PayPal to PayPal Direct Payments: Send to NationalEvents.DPhi@gmail.com
Mail In Payment Option:
Enclose a Money Order or Cashier;s Check Payable to Delta Phi Delta (No Personal Checks Will Be Accepted)
Installment Payment Option:
All Installment Payments Must Be Mailed In. There Will Not Be An Online Payment Option For Installment Payments. There Is
No Non-Lodging Registration until 80 ppl registered and paid. Suggested Payments For The Installment Plan Are As Follows:
5 Equal Payments of $33 Due On - October 1st, October 15th, November 1st, November 15th, and December 1st

PAYMENT ENCLOSED AT TIME OF REGISTRATION
Amount Enclosed:

Payment Balance Due (Installment Plan):
ALL PAYMENTS ARE NON-REFUNDABLE

By signing this registration form, you agree to release Delta Phi Delta Dance Fraternity, Inc, and all its affiliates from ALL liabilities for this event. Also you are agreeing that
you and your roommates will be held solely responsible for any and all damages to hotel property.

Printed Name:
Mail Form & Payment To:
Delta Phi Delta
c/o Sammie Mosley, Jr.
P.O. Box 8071
Champaign, IL 61826

Signature:
Email Form To:

Submit
Confirm All Event Related Information With:
HS Carla Dotson at dphid.nationaleventchair@gmail.com


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