ALPHA SIGMA PHI alphasigmaphi.org
GRAND CHAPTER - ALUMNI TICKETS PERSONAL INFORMATION
ADDITIONAL INFORMATION
Name ___________________________________________________________
Please fill out this form and return it to Fraternity Headquarters via email at
[email protected]. Fraternity staff will make all room reservations, so please do not contact the hotel. If you are flying, it is highly recommended that you take an Uber or Lyft from the airport to the venue. If you must cancel for any reason, there will not be refunds within 30 days of Grand Chapter. Prior to 30 days before Grand Chapter, you will get a full refund minus a $50 administrative fee.
Email Address ____________________________________________________ Phone ( _____ ) ______ – ________ Handicap Accessible Needs
Yes
No
Special Dietary Need(s) ____________________________________________ Emergency Contact _______________________________________________ Emergency Phone ( _____ ) ______ –________ Request a Roommate _____________________________________________ SELECT YOUR TICKET PACKAGE ALPHA BETA GAMMA
DELTA EPSILON
$750 ALUMNUS - Full Weekend (Single)
ZETA
$300 ALUMNUS - Awards Banquet Only (Single)
$550 ALUMNUS - Full Weekend (Double)
ETA
$200 ALUMNUS - Awards Banquet Only (Double)
THETA
$350 ALUMNUS - Full Weekend (No Hotel)
$100 ALUMNUS - Awards Banquet Only (No Hotel)
$675 ALUMNUS - Friday/Saturday Only (Single)
$150 GUEST
$475 ALUMNUS - Friday/Saturday Only (Double)
Please check this box, in addition to your selected package, if you are a delegate for an alumni association.
DISCOUNT CODES Y N
Are you going to be a facilitator at Grand Chapter?
Y N
Will Grand Chapter be your first summer program as an alumnus?
Y N
Are you a Board Member? If so, of which board are you a member?
METHOD OF PAYMENT
Name on Card: __________________________________________________________________ Card Type:
VISA
MasterCard
Discover
AMEX
Card Number:
Expiration Date: ______ / ______ CVV Code: ___________
Confirmation will be sent to the email address documented once your payment is processed. Please contact Fraternity Headquarters if you do not receive a confirmation email.
