Division 3 Convention Registration

  (Please Print All Information)

NAME: ______________________________GRADE:________CHAPTER:______

ADDRESS: _________________________________________________________

CITY: _______________________________STATE: ______ ZIP CODE: _______

STATUS (Circle One): AFSA -- AUX (Circle One): DIV OFF -- CH OFF -- OTHER

CHIEF DELEGATE FOR ACTIVE CHAPTER (Circle): YES -- NO

MEMBER AT LARGE (MAL) (Not assigned to active Chapter-Circle) YES

NAME OF GUEST: __________________________________________________

Is Guest a Delegate (AFSA OR AUX MEMBER- Circle) YES -- NO

REGISTRATION (Full Convention-Includes all 3 meals, refreshments  (coffee, tea, etc., during convention breaks).  Optional Events will be announced.

Pre-registration by 23 March is $75 ________   On Site Registration is  $85) _______  

SEPARATE FUNCTION RATES:  (Please Check Below and List Function(s) on Check)

Thursday Opening Dinner each person - Opening Night Theme is "50s/60s"  $30.00:  Yourself  _______  Guest  _______

Friday Lunch - $15.00 each person: Yourself  _______  Guest  ________  

Saturday Installation/Honors Banquet each person -$40.00: Yourself  _______  Guest  ________  

TOTAL ENCLOSED _____________ Your Check # _____________

Note: Make all checks payable to "AFSA Chapter 358." Be sure to include name of Guest(s) on check unless name is pre- printed on check.  

MAIL REGISTRATION TO: Division 3 Convention Registration Chairman - Rick Aldridge, 15 Glen Forest Drive, Hampton VA, 23669  757-224-2674   mailto:oleschool242@yahoo.com 

Cancellation Policy:   Cancellation notification must be received by Registration Chairman 72 hours prior to start of convention for refund.