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Pi Registration Forms

I acknowledge that If I fail to attend and fully participate in the Preamble Institute I will repay in full the amount spent by the CFO in purchasing my travel arrangements.

First Name *
Middle Name
Last Name *
Suffix, If Any
Preferred Name
Charge *
Institution
Birth Date *
Delegation *
E-Mail *
Mobile Phone *
Secondary Phone
School Address
Home Address *
Travel Options *

Self-booked flights must be approved prior to purchasing. E-mail flight information to Mike Houlihan at mhoulihan@tdx.org. You may include the information now if it is available.
To have the CFO book your flight, please find a flight that fits your needs and e-mail information (airline, flight#, departure times) to mhoulihan@tdx.org. You may include it now if available.
Signature *
Date *