Regional Leadership Travel/Event Request Form

Event/Day of Contact Name

First NameLast Name
Event/Day-of Contact Information
Please enter a valid phone number.
Regional Leadership Travel/Event Request Form

To request Regional Director, Brittani N. Blackwell and/or Regional Representative Ryleigh Clayborn
Name

First NameLast Name
Who are you requesting travel/event engagement for:

Brittani N. Blackwell, Regional DirectorRyleigh Clayborn, Regional RepresentativeBoth (Regional Director & Regional Representative)
Please select the best alignment of the organization making request:

Delta Sigma Theta Sorority, Inc.Divine 9 Organization (NPHC)Greek Letter Organization/College/UniversityNon-Profit/Community OrganizationOther
Please enter chapter name:
No Abbreviations Please
Chapter President's Name

First NameLast Name
Chapter President's Email
example@example.com
Greek Letter Organization:
Information below pertains to the individual completing this form. Please ensure accuracy in information provided as it will used as a point of contact for questions.
Person completing form:

First NameLast Name
Phone Number:
Please enter a valid phone number.
Email Address:
example@example.com
Confirm Email Address:
example@example.com

Event/Travel Request Information
Name of Event:
Expected number of attendees:

Less than 150 people151-300 people301-500 people500+ people
What type of event:

Open to public (anyone can attend/non-restricted attendance)Open to public (restricted attendance/ticketed event)Closed to public (only individuals in group/organization)
Best categorization of event:
Start Date of Event

MonthDayYear
Date
Expected Event Start time

Not desired arrival Minutes

AM/PM Option
End Date of Event

MonthDayYear
Date
Expected End Time

Hour Minutes

AM/PM Option
Anticipated Date of Arrival

MonthDayYear
Date
Anticipated Date of Departure

MonthDayYear
Date
Overnight Hotel Stay (if applicable)
Name of Hotel)
Hotel Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Event Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Event/Day of Contact Name

First NameLast Name
Event/Day-of Contact Information
Please enter a valid phone number.
Responsible Individual for Transportation

First NameLast Name
Responsible Individual for Transportation Contact Information
Please enter a valid phone number.
Is there a theme/focus for event:
Request event attire if applicable:
Please be as specific as possible
Do you have additional event specifics you would like to provide:

YesNot at this time
Event Flyer

Cancelof
Other event specifics you would like to share:

What other dignitaries are attending?
Include full names and positions - also include elected officials
If there is a processional/recessional upload both complete lists here (in one doc./docx file)

If you have any issues with uploading this file please send those lists to ShondraMarshallDST@gmail.com
Cancelof
If there is dias seating upload that seating schematic here

If you have any issues with uploading this file please send the list to ShondraMarshallDST@gmail.com
Cancelof
Do you have designated/reserved seating?

YesNo
Please upload the list of who will be seated in the designated/reserved seating. (upload a doc. or docx file)

If you have any issues with uploading the file please send this list to ShondraMarshallDST@gmail.com
Cancelof
Do you have any additional information which you believe will be helpful for the Midwest Regional Director/Representative to know about this event?
Should be Empty:

Event/Travel Request Information