For Office Use Only:
Date Rec’d: ___________
Amt Paid: $____________
Check #: ______________
Room: 1 2 3 4
Room #: _____________
PHI CHI THETA
MEMBER / VISITOR/ADVISOR REGISTRATION FORM
2016 NATIONAL CHAPTER MEETING – ALEXANDRIA, VA
Hilton Alexandria Mark Center at 5000 Seminary Rd., Alexandria, VA 22331
AUGUST 3-7, 2016
Name:
I am a:
Collegiate/Non-Delegate
Alumni Member of Phi Chi Theta
Advisor
Visitor / Non Member (Note: If you are the Delegate for your chapter, please complete the Delegate
Registration Form)
Permanent Address:
E-Mail Address:
Cell Phone: (
Work Phone: (
)
Date of Initiation into Phi Chi Theta:
Are you a chapter officer for fall 2016?
)
Chapter:
Yes
If yes, which office will you hold?
Previous officers held:
Included with Registration Fee:
 Four Nights Lodging (Aug 3-6) – either private room (Single) or with roommate (Double)
 Meals: Wednesday -Welcome Reception; Thursday - Breakfast & Lunch. Thursday - Alumni Reception
(alumni only); Friday – Breakfast & Lunch; Saturday –Breakfast, Lunch & Awards Banquet;
 Access to all Business Sessions
 Meeting materials
 DC Trolley Tour on Friday;
 Free Hotel Shuttle to/from the Ronald Reagan Washington National Airport.
The group hotel rate of $135 per night (plus taxes) for single/double, $145 for triple and $155 for Quad is available 3 days pre and post conference.
SINGLE OCCUPANCY: $975 if Postmarked by May 15th
($1,000 after May 15th)
DOUBLE OCCUPANCY: $675 if Postmarked by May 15th
($700 after May 15th)
Double Occupancy Roommates: List the roommate that you would like us to put you with. If you do not have
a roommate but need one, please let us know.)
TRIPLE & QUARD ROOMS ARE AVAILABLE BY SPECIAL REQUEST ONLY. CHAPTERS WILL BE
RESPONSIBLE FOR FILLING THE ROOM. (Prices are per person)
TRIPLE OCCUPANCY: $575 if Postmarked by May 15 th
($600 after May 15th)
$530 if Postmarked by May 15th
($555 after May 15th)
QUAD OCCUPANCY:
Total Amount Enclosed:
$
Please make checks payable to PHI CHI THETA. Mail registration form and fees to:
Phi Chi Theta * PO Box113394 * Carrollton, TX 75011-3394
Registration fees may also be paid by credit card. Please contact us to make arrangements. (Note: there will be a credit card processing fee)
If you have any questions, please contact the National Office at
ExecutiveDirector@phichitheta.org or (972) 245-7202