PYA Conference Template

20xx PYA Summer/Winter Conference Registration
City, State
Click for Hotel Reservations
Click for Facebook Event
Full Name*
First NameLast Name
Gender*
MaleFemale
Address*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Phone Number*
Area CodePhone Number
E-mail*
Birth Date*
MonthDayYear
Chapter Name*
Chapter Location*
City, State
Emergency Contact Information:
Contact Full Name*
First NameLast Name
Contact Phone*
Area CodePhone Number
Contact Address*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Relationship to Attendee*
Flight Arrival at Airport (Airport code)
Arrival Time
Airline(s) & Flight Number(s)
Flight Departure from Airport (Airport Code)
Departure Time
Airline(s) & Flight Number(s)
If you are under 18, please print and sign the text waiver and letter of consent. YOU MUST HAVE THIS SIGNED BY A GUARDIAN PRIOR TO YOUR ARRIVAL. Failure to do so will result in participation REFUSAL. Please print this form, sign it with your guardian, and BRING IT WITH YOU.
If you are 18 or over, you can sign these forms upon arrival.
Click for Waiver
Click for Letter of Consent
Acceptance of Terms*
I agree to the statement above, and will print and sign these forms prior to my arrival if I am under 18.
Confirmation*
I have filled out this form accurately, and understand the terms and conditions stated in the waiver of liability and letter of consent.
Packages
Packages include airport/event transportation, daytime events/meals, and nighttime events/meals.
Seperate tickets only available for nighttime events. Transportation not included. Welcome night and White Party Greek Night at the door. Panigiri tickets available for pre-purchase and at door.
PACKAGE PRICES WILL BE RAISED JUNE 16TH
Package Options*
prevnext( X )
$70 PYA Discounted Member Package + $3 Convenience Fee$73.00

$90 Non-Member Package + $3 Convenience Fee$93.00
Should be Empty:

20xx PYA Summer/Winter Conference Registration

Emergency Contact Information:

Flight Arrival at Airport (Airport code)

Flight Departure from Airport (Airport Code)

If you are under 18, please print and sign the text waiver and letter of consent. YOU MUST HAVE THIS SIGNED BY A GUARDIAN PRIOR TO YOUR ARRIVAL. Failure to do so will result in participation REFUSAL. Please print this form, sign it with your guardian, and BRING IT WITH YOU.