31st Annual Regional Convention

$90.00 registration fee per person

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President:

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Please enter all registrants below:

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

	First:	Last:	Advisor	Member	Check Scholarship
	First:	Last:	Advisor	Member	Check Scholarship
	First:	Last:	Advisor	Member	Check Scholarship
	First:	Last:	Advisor	Member	Check Scholarship
	First:	Last:	Advisor	Member	Check Scholarship
	First:	Last:	Advisor	Member	Check Scholarship
	First:	Last:	Advisor	Member	Check Scholarship
	First:	Last:	Advisor	Member	Check Scholarship
	First:	Last:	Advisor	Member	Check Scholarship
	First:	Last:	Advisor	Member	Check Scholarship
	First:	Last:	Advisor	Member	Check Scholarship
	First:	Last:	Advisor	Member	Check Scholarship
	First:	Last:	Advisor	Member	Check Scholarship
	First:	Last:	Advisor	Member	Check Scholarship
	First:	Last:	Advisor	Member	Check Scholarship
	First:	Last:	Advisor	Member	Check Scholarship
	First:	Last:	Advisor	Member	Check Scholarship
	First:	Last:	Advisor	Member	Check Scholarship
	First:	Last:	Advisor	Member	Check Scholarship
	First:	Last:	Advisor	Member	Check Scholarship
	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: February 12, 2010
	Please note: The number of people registered as of February 12, is the number of registrations that the chapter must pay for. Additional registrations may be added after February 12, depending on space available. Refund Policy: No refunds for cancellations after February 12 Receipts: If a receipt is requested, a self-addressed envelope must be included with the payment.