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Eastern Regional Leadership Conference Registration Form
Home
Eastern Regional Leadership Conference Registration Form
First Name
*
Last Name
*
Address
*
City
*
State
*
Zip
*
Phone Number
*
Email
*
Chapter
*
State of Chapter
*
Conference Choice
*
Northern Conference
Southern Conference
Requiring Lodging
*
Yes
No
N/A
When you click Submit - you will be directed to PayPal. The listed prices are as follows:
Collegiate Registration ONLY - $20.88
Alumni Registration ONLY - $31.75
Collegiate Registration + Bus Transportation - $41.46
Alumni Registration + Bus Transportation = $51.75
NOTE: Your registration will not be COMPLETE until your payment has been received.
Name
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