TENNESSEE STATE UNIVERSITY NATIONAL ALUMNI ASSOCIATION NATIONAL CONVENTION REGISTRATION FORM (Please Type or Print)
NAME:
SALUTATION: Dr. Mrs. Mr.
Ms.
Street Address:
City:
State:
Zip Code:
Home Phone Number: ( )
Email Address:
Major:
TSU Graduate: Yes No Alumni Chapter:
Year of Graduation:
Membership Status: Life Millennium Regular
Affiliate Non-Member
Spouse Name/Children/Other (if attending):
Spouse’s Membership Status (if applicable): Life Millennium Regular
Affiliate Non-Member
REGISTRATION OPTIONS Full Registration Options: (Includes convention meals, souvenir gift, yacht and conference materials. Does not include lodging and transportation) Full Registration: $325.00 (Before May 1 st ) Late Registration: $350.00 (May 2 – May 22) # ATTENDING :
ENCLOSED TOTAL PAYMENT
INDIVIDUAL TICKET COSTS: (For Non-registered guests) Yacht Excursion = $75.00 + 150.00 X Qty.____ = $________
$
DIETARY NEEDS: Vegetarian Other __________________________________________________________ Please list any ADA Special Needs: ________________________________________________________________________________ TO RESERVE HOTEL ROOMS: Kempton EPIC Hotel, 270 Biscayne Blvd Way, Miami, FL 33131. Block dates are: June 8-12, 2022. You will receive hotel registration information after your payment is received. PAYMENT INFORMATION REGISTRATION BY MAIL: Please mail completed registration form with payment to: Make Checks Payable To: TSUNAA Tennessee State University National Alumni Association Place in The Memo - 2022 National Convention 3500 John Merritt Blvd. Box 1261 Nashville, TN 37209-1561 ONLINE REGISTRATION – bit.ly/tsunaa66thmiami (starts January 17, 2022) REGISTRATION CANCELLATION POLICY: There are no cancellations for the 66 th National Convention. Transfers: There are no registration transfers for the 66 th National Convention.
FOR COMMITTEE USE ONLY:
Date received: ______________________ Amount received: __________________ Check #: ____________
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