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
Website 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 October 31,2015
Registration: Oct 31, 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:

Total

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

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.___________