183rd Convention – Regional Representative Registration

183rd Convention: Regional Representative Registration

Please use the registration below ONLY if you are a Regional Representative for the Chi Psi Executive Council.

Please contact your Alpha Success Advisor or Kyle Phillips at kphillips@chipsi.org with any technical difficulties or questions regarding undergraduate registration. We look forward to seeing you in Minneapolis!

183rd Convention - UG Regional Representative Registration

Registration for regional reps for the 182nd Annual Convention in Minneapolis, MN.

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 Minneapolis, MN, you are expected to drive. If you live more than 6 hours from Minneapolis, 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. 7/31 - Sun. 8/4?*
- Yes
- No
Which city and state will you be traveling from for Convention on July 31st?
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 August 4th?
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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183rd Convention: Regional Representative Registration

183rd Convention - UG Regional Representative Registration