30th Leadership

University of Virginia, Charlottesville, VA

$25.00 registration fee per person

School:

Other:

Advisor:

Advisor Phone:

President:

President Phone:

Contact email:

Please enter all registrants below:

Check the "veg" box if the registrant prefers a vegetarian meal

First: Last: Advisor Member

First: Last: Advisor Member

First: Last: Advisor Member

First: Last: Advisor Member

First: Last: Advisor Member

First: Last: Advisor Member

First: Last: Advisor Member

First: Last: Advisor Member

First: Last: Advisor Member

First: Last: Advisor Member

First: Last: Advisor Member

First: Last: Advisor Member

First: Last: Advisor Member

First: Last: Advisor Member

First: Last: Advisor Member

First: Last: Advisor Member

First: Last: Advisor Member

First: Last: Advisor Member

First: Last: Advisor Member

First: Last: Advisor Member

Mail payment to:

Michael Brown

PO Box SVCC, Southwest Virginia Community College

Richlands,VA 24641

Please make checks Payable to:

Phi Theta Kappa of Virginia EIN #91-1777-607

Deadline for registration is: September 11

Please note:
The number of people registered as of September 11, is the number of registrations that the chapter must pay for.

Additional registrations may be added after September 11, depending on space available.

Refund Policy: No refunds for cancellations after September 11

Receipts: If a receipt is requested, a self-addressed envelope must be included with the payment.