OMEGA PSI PHI FRATERNITY, INC

71st TWELFTH DISTRICT MEETING

May 19-22, 2016
Phi Iota Chapter (Phoenix, AZ)
Hyatt Regency-Downtown Phoenix
122 North 2nd Street
Phoenix Arizona 85004
Tel: 602.252.1234 Fax: 602.254.9472
Hotel Reservation Link: https://resweb.passkey.com/go/OmegaPsiPhi12
www.71stdistrictmeeting.com
Charles Peevy, 12th District Marshal 71stdistrictmeeting@gmail.com
NAME___________________________________________________________ CONTROL # ________________ OLMF # _______
LAST
FIRST
MI
ADDRESS_______________________________________________________________________________________________________
STREET
APT# CITY
STATE
ZIP CODE
EMAIL ________________________________________________YEAR INITIATED & CHAPTER___________________________

CURRENT CHAPTER________________________________ LOCATION _______________________________________________

OCCUPATION _________________________________________________

PHONE # _______________________________

ATTENDANCE STATUS
DIST/ NATL OFFICER______________________________ VISITOR

___________________________________________

QUETTE

if yes Name ________________________________

YES__________ NO ____________

SCHEDULE OF FEES: (Registration includes Founders Banquet,

Undergraduate Luncheon and Step show / Friday night dance ticket)

Graduate Undergraduate

MSP Registration (brothers initiated into OMEGA since the last district meeting)
Early Bird-Registration: May 27, 2015 May 31, 2015 (Oakland ONLY)
Pre-Registration: June 1, 2015 Sep 30, 2015
Registration: Oct 1, 2015 February 28, 2016
Late Registration: February 29, 2016 May 18, 2016 (Souvenirs Not
Guaranteed)
On Site: May 19,2016 May, 22, 2016 (Souvenirs Not Guaranteed)
Visiting Brothers (Grand Officers Exempt)
Golf Tournament Handicap Flight A B C (Separate Cost)
Quette Package (does not include tickets to any events)
Extra Undergraduate Luncheon Ticket
Extra Founders Banquet Ticket
Extra Step Show / Friday Night Dance Ticket
District Meeting Group Photo
Thursday Night Special Entertainment
Total Due
Make checks payable to:

150.00
130.00
160.00
225.00

100.00
50.00
50.00
50.00

250.00
275.00
150.00
125.00
100.00
45.00
60.00
25.00
15.00
30.00

70.00
70.00
60.00
125.00
100.00
45.00
60.00
25.00
15.00
30.00

Total

OMEGA PSI PHI FRATERNITY, INC

71st 12th District Meeting
PO Box 3441 Phoenix, AZ 85030

-------------------------------FOR HOST CHAPTER ONLY-----------------------------------Form of Payment

Cash__________
Registration #______________ Cashiers Check ________
Date Recd _________________ Check
_______
Amount Recd ____________
Money Order _______

Amount__________
No. _____________
No.______________
No.___________