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2027 DSA
Representative Registration Form
Complete One Only One Time Please is you need to edit your submission contact 

_____________ at (999)999-9999

Temple

$90 per representative registration. Includes two President's Banquet tickets and one Ladies' Luncheon ticket.

OPTIONAL — Your $90 Representative registration includes up to 2 President's Banquet tickets. Enter 0, 1, or 2 for the number of tickets you will use. Additional guests must register separately using the Non-Representatives form.

OPTIONAL — Your $90 Representative registration includes 1 Ladies' Luncheon ticket. Enter 1 if attending or 0 if not attending. Additional guests must register separately using the Non-Representatives form.

REGISTRATION FEES & PAYMENT INFORMATION

Representative Registration: $90.00

Your $90 Representative registration includes:

  • One Representative registration

  • Up to two President's Banquet tickets

  • One Ladies' Luncheon ticket

ADDITIONAL GUESTS: Any additional adults, family members, or guests not covered by the Representative registration package must register separately using the 2027 DSA Non-Representatives Registration Form. Additional registrations and event tickets are subject to the applicable Non-Representative fees.

PAYMENT INFORMATION: No payment will be collected through this form. After submitting your registration, you will receive an email confirmation with your registration details and total amount due once the confirmation system is activated and payment methods.

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© 2027 Dixie Shrine Association

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