2020 Preamble Institute Delegate Registration

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

This form is for the required Charge delegate to the 2020 Preamble Institute. Please complete the form in full. You will be contacted by John Lowry to book your travel, this will happen within a few weeks of completing the form. You can contact Brother Lowry at 800.999.1847 ext. 2 proactively to book your travel to the event.

Full Name *

Charge *

Alpha

Beta

Beta Deuteron

Delta Deuteron

Epsilon Triton

Eta Deuteron

Gamma Deuteron

Gamma Triton

Iota Triton

Lambda Deuteron

Lambda Triton

Mu Triton

Nu Triton

Omicron Deuteron

Psi Deuteron

Psi Tetraton

Rho Proteron

Rho Triton

Sigma Deuteron

Sigma Triton

Tau Tetraton

Tau Triton

Theta Deuteron

Theta Triton

Upsilon Deuteron

Xi Deuteron

Xi Triton

Birth Date

YYYY

Delegation (Usually four years from your first year of school) *

E-mail *

Phone (Mobile) *

Select a Travel Option

Fly

Drive

Bus

Train

I will be in New Jersey

Clear selection

Confirm Registration: I acknowledge that if I fail to attend and fully participate in the 2020 Preamble Institute (New Brunswick, NJ, 01-17-19 to 01-20-19) my Charge will be responsible for repaying the Grand Lodge the full cost of attending (lodging, flight, etc.) *

I Agree

Substance Policy: I understand that the Preamble Institute is an alcohol and substance free weekend and that in violating this policy I will not be reimbursed for my travel costs and will be billed for my cost of attending or I will be billed for my travel cost and the cost of attending if travel has already been paid for. *

I Agree

Dietary Requirements and other Accommodations: Please list any food allergies and dietary requirements. You may also use this space to request additional health or mobility accommodations.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Theta Delta Chi. Report Abuse

Forms