Omega Psi Phi Fraternity, Inc.

71st 12th District Meeting

May 19 22, 2016
Hyatt Regency, Downtown
122 N. 2nd Street
Phoenix, AZ 85004
Phone (602)252 - 1234
VENDOR APPLICATION FORM

Company Name: ______________________________________________

Vendor Name: ______________________________________________________
Business Address: __________________
Phone & Email: _________________________________

Vendor Booth: ($200) ____

Vendor Booth & Full Page Ad ($350)__________

** Vendors selling Omega Paraphernalia must be registered with International Headquarters

Make checks payable to: OMEGA PSI PHI FRATERNITY, INC

71st 12th District Meeting

PO Box 3441 Phoenix, AZ 85030
(Cashiers check or Money Orders Only)

Inquiries: Clyde Miller 602.253.6904

Email: clydemiller@tcdccorp.org

FOR HOST CHAPTER USE ONLY

DATE RECEIVED_________________________________
FORM OF PAYMENT: CASHIERS CHECK___________MONEY ORDER____________
AMOUNT RECEIVED_______________________
Edgar A. Love, DD

Manhood

Oscar J. Cooper, MD

Scholarship

Frank Coleman, MS

Perseverance

Ernest E. Just, PH.D.

Uplift