Centennial Court - 100 Club Waitlist

Centennial Court - 100 Club Waitlist
If you experience any technical issues with this form, email technology@dstsouthernregion.com.
The Centennial Court - 100 Club Benefits:
- Name Recognition - your name proudly listed in the digital Conference Souvenir Journal
- Exclusive Digital Frame - showcase your Centennial pride with a custom digital frame
- Commemorative Keepsake - created exclusively for this celebration
- Centennial Polo - show your pride with a special edition polo
- Conference Badge Distinction - special designation identifying as a Centennial Court - 100 Club member
Name

First NameLast Name
Email
example@example.com
Phone Number
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Member Number
Member Type
Alumnae Chapter Name
Collegiate Chapter Name
Type chapter here (No abbreviations. Include college/university for collegiate chapters.)
Chapter State
Chapter of Initiation (No abbreviations. Include college/university for collegiate chapters.)
Year of Initiation
Undergraduate College
Polo shirt size (ladies cut)
Specs/Guidelines for photos:
- Submit high-resolution images
- Avoid screenshots, compressed images, or photos downloaded from social media
- File size should ideally be 1MB or larger for clarity
- Accepted formats: JPG or PNG
- Ensure you are centered and clearly visible
- Avoid extreme close-ups or images where the face is too small or too far away
- Portrait or square images work best
- Avoid dark, blurry, pixelated, or heavily filtered images
- Make sure the image is in focus and not grainy
- Do not submit images with existing frames or borders
Please allow 48-72 hours to receive your personalized frame.
Headshot (Only ONE headshot is allowed)

Maximum size: 3 MB. Valid file types: jpg, jpeg, png
Cancelof
Centennial Club commemorative items are pickup only during the 50th Regional Conference in Atlanta, GA. Items will not be shipped.

If you are unable to attend, designate someone who is attending the Regional Conference to pickup for you.
Are you attending Regional Conference
Pickup Person

First NameLast Name
Pickup Person's Email
example@example.com
Pickup Person's Member Number
Pickup Person's Chapter
Type the Pickup Person's Chapter (no abbreviations).
Should be Empty: