Sigma Zeta National Convention Chapter Registration Form

Sigma Zeta National Convention Chapter Registration Form

2008 National Convention
April 3 - 5, 2008
University of Indianapolis
Indianapolis, Indiana

Please submit abstracts electronically using the form below no later than March 17, 2008. Please submit only one registration per chapter if possible.

If needed look up your Chapter Name for the Chapter Name entry below.

Chapter*

School*

Chapter Advisor/Contact Person:

Name*

Email:*

Phone:

Address

City

State

Zipcode:

Attendee Information:

Number Attending:

Number Students Attending:

Number Faculty Attending:

Total Number Attendees:

Number Presenting:

(Please submit an abstract form for each presenter/poster.)

Please list all members attending (First Last, First Last....) as well as any special physical or dietary needs:

Convention Attendee List:*

Registration Fee: ($25.00/person attending - Make Checks Payable to the Hosting University and place Sigma Zeta on the memo line of the check. Fees can be paid in advance by mailing to the Convention Host or can be paid during registration.)

Registration Fees ($25.00 X #attendees): $

Planned Arrival Time:

Arrival Date (mm/dd/yy)

Arrival Time (hh:mm am/pm)

Field Trip Information and Links

Number Participating in Field Trip

Indianapolis Motor Speedway

Trip1

Indiana Medical History Museum

Trip2

Dow Agro Sciences (Advance Registration Required - Please identify name in Attendee list above as names of visitors must be submitted in advance. )

Trip3

After submitting you should receive a confirmation page and also a confirmation email.

Mail a printed copy of the above form (or your confirmation) and payment (Check made out to University of Indianapolis. Please include Sigma Zeta on the memo line on the check. ) to:

Joe Burnell
Chemistry Department
University of Indianapolis
1400 East Hanna Avenue
Indianapolis, IN 46227
Phone: (317) 788-3284