CHAPTER INFORMATION
CHAPTER NAME (INCLUDING CHAPTER #):
*
LOCATION (CITY & STATE):
*
AFFILIATION:
*
AHEPA
DAUGHTERS OF PENELOPE
CHAPTER CONTACT NAME:
*
First Name
Last Name
POSITION:
*
EMAIL:
*
example@example.com
TELEPHONE:
*
Please enter a valid phone number.
ADDRESS:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
TEAM SPONSORSHIP INFORMATION
Chapters are encouraged to sponsor specific teams. Those chapters sponsoring specific teams need to list the team and the student names below, while having each student independently fill out the “Student Registration Form.” Chapters who cannot find a specific team but still wish to sponsor a team can elect so and will be assigned a team.
TEAM NAME:
TEAM CAPTAIN:
My Products
prev
next
( X )
We are sponsoring a specific team
$
350.00
We would like a team assigned to us
$
350.00
Payment Methods
Debit or Credit Card
Choose from one of the PayPal options to
make your payment.
Submit
Should be Empty: