Midwest Regional Convention Registration

Midwest Regional Convention Delegate Registration

Hosted by District 10 (MI), District 11 OH, KY, & WV), District 12 (IN), District 13 (IL & WI) and District 14 (MN, IA, MO, NE, ND, & SD)
Please note that EACH delegate needs to complete their own registration, but a delegate can register each of their guests.
Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
DISTRICT*
I'M A MEMBER OF:*
MY CHAPTER NUMBER IS:*
CONVENTION REGISTRATION
My Products
prevnext( X )
DELEGATE REGISTRATION

$175.00 Quantity

GUEST REGISTRATION

$175.00 Quantity

Total

$0.00
Guest Names

Please include the names of each guest for which you are paying.
ENTER GUEST NAMES
Include a ";" between names.
PAYMENT

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Midwest Regional Convention Delegate Registration