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Officers

District Representative:
Keith R. Jackson

1^st Vice District Representative:
David Marion

2^nd Vice District Representative:
Stephen Jackson

Keeper of Records & Seal: Andrew T. Ducksworth

Keeper of Finance :Harry Harrell

Public Relations:
Darron Toston

District Counselor: Malcolm Harrison

District Chaplain: Archie Smith

Omega Psi Phi Fraternity, Inc
73^rd Seventh District Meeting

March 25 - March 28, 2010
Host Chapters: Tau and Beta Psi
Renaissance Atlanta Hotel - Atlanta, Georgia

Online Pre-Registration Form

(Note: A separate form must be completed for each Brother)

Control Number:
Current Chapter:		Location:
First Name:	MI:	Last Name:
Home Address:		City:
State:		Zip:
Home Phone:	() -	Work Phone:	() -
Quette Name:		Child(ren)'s Name:
Email:

Type of Registration: (Select One)

Graduate Delegate ($185)

Graduate Visiting ($185)

Graduate Host ($185)

Graduate MSP Delegate (Initiated after 4/1/2009) ($50)

Graduate MSP Visiting (Initiated after 4/1/2009) ($50)

Undergraduate Delegate ($160)

Undergraduate Visiting ($160)

Undergraduate Host ($160)

Undergraduate MSP Delegate (Initiated after 4/1/2009) ($50)

Undergraduate MSP Visiting (Initiated after 4/1/2009) ($50)

District Council (No Fee)

Supreme Council (No Fee)

Request for refunds must be sent to the DKRS
in writing or via email by March 5, 2010.

* Delegate must also complete and mail
Form 36 (CREDENTIALS FOR CHAPTER DELEGATES) to:

Bro. Andrew Ducksworth
7^th District KRS
5150 Coventry Creek Drive
Cumming, Georgia 30040
Telephone: (678)520-3410
Email: 7thdistrictKRS@oppf.org

MUST BE POSTMARKED BY February 15, 2010. A Form 36 (CREDENTIALS FOR CHAPTER DELEGATES) is included in the Registration Package and can be downloaded by clicking here.

Qty	Activity	Amount
1	Basic Pre-registration fee includes (Souvenir Portfolio, Admission to Undergraduate Luncheon, Life Membership Luncheon, Marchdown Competition, and Founders Banquet)	$
	Additional Founder's Banquet @ $40.00 each	$
	Casino Night (Friday, March 26th) @ $25.00 each	$
	Dance (Saturday, March 27th) @ $20.00 each	$

Sub Total $

Processing Fee $

GRAND TOTAL $

By completing the on-line registration Card Holder acknowledge receipt of goods and or services in the amount of the total shown and agrees to perform the obligation set forth in the Card Holder's agreement with the issuer of said card. Request for refunds must be sent to the 7th District KRS in writing or via email by April 1, 2010.

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