First Name:     Last Name:

First Name as you would like it on your nametag:

Chapter/Colony: None (Other Guest) Abracadabra Alabama Albany Colony Alberta American Appalachian State Arizona Arizona State Auburn Augusta Behrend Binghamton Bowling Green Bryant Cal Poly California Univ - PA Central Michigan Central Missouri Chico Cincinnati Colony Clemson Coastal Carolina Colorado State Connecticut Cornell Corpus Christi Colony Cortland Davis Denison DePauw Duquesne East Carolina East Stroudsburg Colony Eastern Illinois Colony Eastern Washington Colony Embry-Riddle Ferris State Florida Florida State Colony Fredonia Frostburg Fullerton Gannon George Mason Georgia Southern Georgia Tech Gorham State Hamilton Colony Hayward Hobart Hofstra Huntsville Idaho Illinois Illinois State Indiana Iowa Jacksonville State James Madison Johnstown Kansas Kennesaw Colony Kent State Kettering-A Kettering-B L.S.U. Lake Forest Lehigh Colony Livingston Colony Long Beach Louisiana Tech Mankato Marquette Marshall Maryland Massachusetts Colony Miami Michigan Michigan State Minnesota Mississippi State Missouri Missouri State Montclair Montevallo New Haven North Alabama Colony Northern Arizona Northern Colorado Northwest Missouri Northwestern Ohio State Colony Oklahoma Colony Oregon State Oshkosh Penn State Pittsburgh Purdue Radford Rhode Island Rowan Rutgers Sacramento State Colony Slippery Rock South Dakota State South Florida Southeast Missouri Southern California Southern Illinois Stephen F Austin Syracuse Tarleton Texas Texas A&M Texas Tech Tri-State Troy State Truman State UNLV USP Colony Valdosta Virginia Washburn Washington Washington State West Chester West Georgia West Virginia Tech Western Michigan Whitewater Colony William & Mary Wilmington Colony Windsor   Grad Year: 20

Phone Number: Cell Home

E-mail Address:

Confirm E-mail:

Birthday (mm/dd/yyyy):

T-Shirt Size: Select Size Small Medium Large Extra Large 2X Large 3X Large

Do you have any allergies? No Yes

Do you have any dietary requests?
No Vegetarian Other

In case of an emergency, please contact:

Relation:    Phone Number:

When were you elected "A": mm/yyyy

When does your term end:   mm/yyyy

Do you feel you had an effective officer transition? Yes No

Have you met with your Academy 2009 attendee? Yes No
If not, please make sure to do so prior to your arrival in St. Meinrad.

I will be: Driving Flying