182nd Convention – Undergraduate Regional Rep Registration

Regional Representative Registration

If you are an undergraduate regional representative attending the 182nd Annual Convention, please register here. Non-delegate undergraduate registration will be open soon.

182nd Convention - UG Regional Representative Registration

First Name*
Middle Name*

If you do not have a middle name, please write "none."
Last Name*
Suffix
Preferred Name for Nametag*

For your name tag at Convention.
Date of Birth*
Alpha Designation*
Graduation Year (Expected)*
Are you also a registered undergraduate delegate (current #1, #4, #5, or Recruitment)?
- Yes
- No
Position(s) Currently Held in Alpha*
Preferred Phone Number*
Preferred Email Address*
Which state is listed on your driver's license/government-issued ID?*

If you are an international student, please type "N/A."
If you are not a resident of the U.S., what is your country of residence?
Transportation Type*
- Flying
- Driving
If you live within 6 hours of Atlanta, GA, you are expected to drive. If you live more than 6 hours from Atlanta, you may fly OR drive, but please indicate here. Those flying will have flights booked for them by the Central Office.
What is your Known Traveler Number?

If you don't have a KTN, you may ignore.
If driving, please provide estimated arrival date and time:

Add mode of transportation, arrival date and time, and any other relevant information.
Do you commit to attending Convention from Weds. 7/26-Sun. 7/30?*
- Yes
- No
Which city and state will you be traveling from for Convention on July 26?
Preferred Airport to depart from?

Only if your city has multiple (ex. JFK/LGA/EWR)
Which city and state will you be traveling back to after Convention on July 30?
Preferred SUNDAY departure time?

Ex. Early Morning, Before Noon, Afternoon, No Preference (please note this is preference only, we cannot guarantee your departure time)
List any food allergies here.*

Please put "none" in the form if this doesn't apply to you
List any medical conditions here.*

Please put "none" in the form if this doesn't apply to you
Emergency Contact Name*
Emergency Contact Phone Number*
Other Notes About Travel Plans

Please include any other important notes about your expected travel plans here.

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Regional Representative Registration

182nd Convention - UG Regional Representative Registration