Middle Western Province Kappa League Conference

REGISTRATION INFORMATION

Complete from with student information

Student Name *

First

Last

Address

Address Line 1 *

City *

State *

Zip Code *

Phone *

i.e. 314-555-5555

Email Address *

Chapter Name *

Grade Level *

EMERGENCY CONTACT INFORMATION

In case of emergency please provide the best contact.

Emergency Contact Name *

First

Last

Emergency Contact Phone *

i.e. 314-555-1234

REGISTRATION INFORMATION

Some description about this section

Registration Type *

Individual Registration Group Registration (Individual attending with group) $75 registration fee per student. We will contact group leader for "group payments" and t-shirt orders.

T-Shirt Size

DIETARY REQUIREMENTS

Contact us if you do not see your choice listed below.

Please select all of them below that describe you

No Restrictions Gluten Free Vegetarian Plant Base (Vegan) Have food allergies

Vegaterian

No Red Meat No Chicken No Fish No Egg No Pork No Dairy Products

I only eat plant foods and plant products

Yes, plant food and products only No, there are exceptions

Food Allergies

Please give additional detail about your diet here

Middle Western Province Kappa League Conference

June 5, 2025 –Sunday, June 8, 2025

REGISTRATION INFORMATION

EMERGENCY CONTACT INFORMATION

REGISTRATION INFORMATION

DIETARY REQUIREMENTS