IB 362

7/07

(ES)

DELTA OMICRON

INTERNATIONAL MUSIC FRATERNITY

CONFERENCE COLLEGIATE DELEGATE AND ALTERNATE

Send this form to the Executive Secretary and a copy to the Province President after the chapter’s delegate and alternate are selected. The form should be postmarked no later than April 1 in the year of the Triennial Conference. If the delegate’s registration fee has not yet been paid, a check in the amount of the registration fee should accompany this form mailed to the Executive Secretary.

Chapter __________________________ Province _______________________

Name of Conference Delegate _________________________________________________________

(not a graduating senior)

School Address _____________________________________________________________________

School Phone _______________________________________________________________________

E-Mail Address _____________________________________________________________________

Summer Address ____________________________________________________________________

Summer Phone __________________________________

Name of Conference Delegate Alternate _________________________________________________

(will attend if delegate cannot)

School Address _____________________________________________________________________

School Phone _______________________________________________________________________

E-Mail Address _____________________________________________________________________

Summer Address ____________________________________________________________________

Summer Phone __________________________________