IOTA PHI THETA FRATERNITY, INC. 38th International Conclave Delegate Registration Form
This application form will be used as a working document and therefore it must be completed in its entirety.
Please return this completed form to Brother Akeem Boneparte. via email at
conclaveregistrar@iotaphitheta.org.

Pursuant to Article IV, Section 4 and Section 5 of the Fraternity Bylaws, chapters must register and
designate a delegate and an alternate delegate to attend Conclave.

Pursuant to Article Vll, Section 2 and Article X, Section 3.4 of the Fraternity Bylaws, only Brothers that
have an active status can serve in the capacity of a delegate and alternative delegate to the Conclave.
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38th International Conclave Delegate Registration Form
Chapter Name *
Region
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Delegate Information Section
Please Enter Delegate Information (First & Last Name, Address, City, State, Zip Code, Cell Phone, Membership Number, Email Address)
Name (First, Middle Initial , Last) *
Address (Address, City, State, Zip Code) *
Cell Phone Number *
Membership ID *
Email Address *
Alternate Delegate Information
Please Enter Alternate Delegate Information (First & Last Name, Address, City, State, Zip Code, Cell Phone, Membership Number, Email Address)
Name (First, Middle Initial , Last)
Address (Address, City, State, Zip Code)
Cell Phone Number
Membership ID
Email Address
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