Registration

Please fill out the following form and submit by March 5 it in order to register for the 2008 New England Regional Convention. If you have any questions, please contact Michelle Brinck at mbrinck@ncc.commnet.edu.

The registration fee per attendee is $80.00 (USD). Prompt payment should be mailed to:

Ms. Michelle Brinck
Coordinator - New England Region
Phi Theta Kappa International Honor Society
c/o Norwalk Community College
188 Richards Avenue
Norwalk, CT 06854

Please make out all checks to “Phi Theta Kappa New England.”

We look forward to seeing you in Nashua!

Contact Information

Chapter

(required)
Name
(required)
Email
(valid email required)
Phone Number
(required)

Conference Attendees

Attendee One:
Name
Attendee Position
Days Attending
Attendee Two:
Name
Attendee Position
Days Attending
Attendee Three:
Name
Attendee Position
Days Attending
Attendee Four:
Name
Attendee Position
Days Attending
Attendee Five:
Name
Attendee Position
Days Attending
Attendee Six:
Name
Attendee Position
Days Attending
Extra Attendees can be added to the notes box below.

Notes
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Regional Convention

of the New England region of Phi Theta Kappa

Registration