R E G I S T R A T I O N
Fields marked with an asterisk
*
are required.
Primary Attendee Information
Archon / Delegate / Widowed Archousa
Registration Fee
Date
-
Month
-
Day
Year
Date
Registration Type
*
Make a selection
Archon
Delegate
Alternate Delegate
Widowed Archousa
Attendee Name
*
First Name
Last Name
Member Boulé
*
Make a selection
Alpha – Philadelphia, PA
Gamma – Baltimore, MD
Zeta – New York, NY
Mu – Northern NJ, NJ
Rho – Pittsburgh, PA
Alpha Kappa – Buffalo, NY
Alpha Sigma – Brooklyn/Long Island, NY
Alpha Psi – Hartford, CT
Beta Beta – Boston, MA
Beta Zeta – Westchester Co., NY
Beta Eta – State of DE, DE
Beta Iota – Farmington Valley, CT
Beta Mu – Suburban MD, MD
Beta Nu – Northern VA, VA
Beta Pi – Harrisburg, PA
Beta Sigma – Springfield, MA
Beta Tau – New Haven, CT
Beta Psi – Albany, NY
Gamma Theta – Princess Anne, MD
Gamma Iota – Rochester, NY
Delta Epsilon – Southern NJ, NJ
Delta Nu – Fairfield, CT
Epsilon Zeta – Loudon County, VA
Member Title
*
Make a selection
Archon
Grand Sire Archon
Grand Sire Archon-Elect
Immediate Past Grand Sire Archon
Past Grand Sire Archon
Grand Grammateus
Grand Assistant Grammateus
Grand Thesauristes
Grand Rhetoricos
Grand Agogos
Grand Grapter
Regional Sire Archon
Regional Grammateus
Regional Thesauristes
Regional Rhetoricos
Regional Agogos
Regional Grapter
Widow Archousa
E-mail
*
Contact Phone#
*
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Special Dietary Needs
*
None
Gluten Free
Vegetarian
Vegan
Allergic to Nuts
Allergic to Seafood
Allergic to Shellfish
Other
Special Assistance Needs (Wheelchair, etc.)
*
No
Other
Will you be attending any of the included sessions?
*
Regional Executive Committee Meeting - Thursday
Welcome Reception Crab Feast - Friday
Open Session Public Forum - Saturday
Northeast Region Business Meeting - Saturday
Archousia Luncheon - Saturday
Northeast Region Gala - Saturday
Memorial Service - Sunday
Farewell Brunch - Sunday
Will you be playing golf? (Additional $175 fee includes continental breakfast, greens fees & lunch. Club rentals available on-site)
*
Yes
No
Golf Handicap
*
1
2
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5
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36
Arrival Date
*
Please Select
Thursday, September 28 or earlier
Friday, September 29
Saturday, September 30
Sunday, October 1
Expected date of arrival
Departure Date
*
Friday, September 29
Saturday, September 30
Sunday, October 1
Expected date of arrival
Archousa / Spouse Attending?
*
Yes
No
Guest / Significant Other Attending?
*
Yes
No
Archousa Section
Archousa Information
Archousa Name
*
First Name
Last Name
E-mail
*
Special Dietary Needs
*
None
Gluten Free
Vegetarian
Vegan
Allergic to Nuts
Allergic to Seafood
Allergic to Shellfish
Other
Special Assistance Needs (Wheelchair, etc.)
*
No
Other
Will you be attending any of the included sessions?
*
Welcome Reception Crab Feast - Friday
Open Session Public Forum - Saturday
Archousia Luncheon - Saturday
Northeast Region Gala - Saturday
Memorial Service - Sunday
Farewell Brunch - Sunday
Will you be playing golf? (Additional $175 fee includes continental breakfast, greens fees & lunch. Club rentals available on-site)
*
Yes
No
Golf Handicap
*
1
2
3
4
5
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10
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36
Need to register another Guest?
*
Yes
No
Guest 1 Section
Guest 1 Information
Significant Other / Non-Archousa
Guest 1 Name
*
First Name
Last Name
E-mail
*
Special Dietary Needs
*
None
Gluten Free
Vegetarian
Vegan
Allergic to Nuts
Allergic to Seafood
Allergic to Shellfish
Other
Special Assistance Needs (Wheelchair, etc.)
*
No
Other
Will you be attending any of the included sessions?
*
Welcome Reception Crab Feast - Friday
Open Session Public Forum - Saturday
Archousia Luncheon - Saturday
Northeast Region Gala - Saturday
Memorial Service - Sunday
Farewell Brunch - Sunday
Will you be playing golf? (Additional $175 fee includes continental breakfast, greens fees & lunch. Club rentals available on-site)
*
Yes
No
Golf Handicap
*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
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36
Need to register another Guest?
*
Yes
No
Guest 2 Section
Guest 2 Information
Significant Other / Non-Archousa
Guest 2 Name
*
First Name
Last Name
E-mail
*
Special Dietary Needs
*
None
Gluten Free
Vegetarian
Vegan
Allergic to Nuts
Allergic to Seafood
Allergic to Shellfish
Other
Special Assistance Needs (Wheelchair, etc.)
*
No
Other
Will you be attending any of the included sessions?
*
Welcome Reception Crab Feast - Friday
Open Session Public Forum - Saturday
Archousia Luncheon - Saturday
Northeast Region Gala - Saturday
Memorial Service - Sunday
Farewell Brunch - Sunday
Will you be playing golf? (Additional $175 fee includes continental breakfast, greens fees & lunch. Club rentals available on-site)
*
Yes
No
Golf Handicap
*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
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36
Registration Fees
Registration Fees
Golfer Fees
Registration Subtotal
Payment Due
Amount Due At Checkout
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USD
2017 NER Biennial Registration Fee
Total Registered
Total Golf
Notes
COMPLETE REGISTRATION & PAYMENT
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