17th General Assembly Registration Form

Online Registration Form
Limited Special Offer: Gala night table of ten seats at discounted rate of $1,000 for organizations or groups
(paid & postmarked by June 15, 2013).

* Indicates required field

Name *

First

Last

Spouse/Guest *

Mailing Address *

Email *

Phone Number *

Degree and Year Completed at University *

If Spouse is alumnus, include degree and year *

If you belong to the following celebrating classes, please contact Erlinda Rojas-Santos ([email protected]) for specific instructions regarding the Parade of Jubilarians during Gala Night on August 31, 2013.
A Jubilarian is required to register in full.

Select One *

A Convention Delegate is a U.P. Alumnus who has PAID IN FULL the registration fees. He/She is eligible to vote at the Election of Officers on August 31, 2013. He/She will receive the registration packet, tickets to all convention events/meals, and the souvenir program upon registration on Aug 30, 2013.
Registered Spouses and Guests are not eligible to vote, but will receive the registration packet and tickets to paid
Individual events .

FEES:
Early Bird Registration   (Paid & Postmarked June 15, 2013)
Convention Delegate                     $200
Spouse/Guest                                   $180

Individual Events:
Aug 30 Fellowship Night $50
Aug 31 Breakfast, Symposium, Lunch & Afternoon Sessions   $120
Aug 31 Gala & Dinner Dance     $120

Regular and On-Site Registration (Paid & Postmarked after June 15, 2013)
Convention Delegate                     $250
Spouse/Guest                                  $230
Individual Events:
Aug 30 Fellowship Night $50
Aug 31 Breakfast, Symposium,  Lunch & Afternoon Sessions    $135   Aug 31 Gala & Dinner Dance       $125

Payment Options *

** If mailed in payment option is chosen, you will need to follow up with us via e-mail or phone call 1 to 2 weeks after the payment is mailed for confirmation of the receipt of the payment.

By checking on this box, you have confirmed all information entered above. You have also agreed to pay the indicated amount in order to be confirmed as an attendee for the convention and other events. Upon submission, an email confirmation will be sent to you and a link to an online payment site through Paypal will be included. You may pay the amount using your major credit or debit card. A receipt will be mailed to you. For questions or concerns. Contact us at [email protected] *

I Agree

Submit

Online Registration FormLimited Special Offer: Gala night table of ten seats at discounted rate of $1,000 for organizations or groups (paid & postmarked by June 15, 2013).

Online Registration Form
Limited Special Offer: Gala night table of ten seats at discounted rate of $1,000 for organizations or groups
(paid & postmarked by June 15, 2013).