Omicron Delta - Conference Registration Page

Omicron Delta Conference Registration

ALERT: This page is a registration page only. Once you confirm the information on this page and hit the "submit application" button you will be connected to a secure server and you will see the SSL or "lock" on the bottom right hand corner which confirms your payment information is secure.

The information you provide on this form will be used for your conference registration. Please make sure your email and phone number are correct in case we need to contact you. Once your registration is submitted and payment is completed you will receive a confirmation email that will serve as your proof of registration. If you don't receive a confirmation to the email that you entered, please contact the chapter to confirm your registration. (email: administrator@omicrondelta.net)

Conference Name: Facing Our Current Reality: The Need For Radical Leadership.

*Conference Fee:

Full Conference Program ($65) Full Conference Program Retiree Rate ($40)

Credit Card Information

Please enter the number and expiration date of the credit card that you would like to use to pay for your Conference Fee.

We Accept
Visa | MasterCard

*Card Number:
*Expiration Date:

Customer Billing Information

Please enter the information below EXACTLY as it appears on your credit card billing statement for the card number entered above.

*First Name:
*Middle Initial:
*Last Name:
*Address:
*City:
*State/Province:
*Zip/Postal Code:
*Country:
*Phone:
Fax:
*E-Mail:

Customer Contact Information (if different from above)

First Name:
Middle Initial:
Last Name:
Address:
City:
State/Province:
Zip/Postal Code:
Country:

By clicking the "Submit Registration" button below, you will be submitting this form to our credit card processing company. Your credit card and billing information will be displayed on a secure form, and you will have an opportunity to make corrections or changes before your card is charged.