2017 MSLA SPRING REGIONAL PHI THETA KAPPA CONFERENCE CHAPTER REGISTRATION FORM
OLE MISS: MARCH 3 - 4, 2017
Phi Theta Kappa Chapter Name *
Your answer
College Name
Your answer
Campus Name *
Your answer
Contact Name *
Your answer
Contact Email Address *
Your answer
Mailing Address *
Your answer
Order of the Golden Key Award ($25)
Number of Regional Advisory Board Members *
REGISTRATION FEE WAIVED
Number of Regional Officers *
REGISTRATION FEE WAIVED
Number of Chapter Advisors : $65 per person (late registration is $85 after Feb 16) *
Do Not Include REGIONAL ADVISORY BOARD MEMBERS
Number of Students - $65 per person (late registration is $85 after Feb 16) *
Do Not Include REGIONAL OFFICERS
MSLA REGION T SHIRTS (Small - $15): Pre-order
MSLA REGION T SHIRTS (Medium - $15): Pre-order
MSLA REGION T SHIRTS (Large - $15): Pre-order
MSLA REGION T SHIRTS (Extra Large - $15): Pre-order
MSLA REGION T SHIRTS (2X Large - $15): Pre-order
MSLA REGION T SHIRTS (3XLarge - $15): Pre-order
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