RA Registration Form

Member Information

Name*

First Name

Last Name

TSEA Member ID (Last 4 of SS#)*

Last 4 of Social Security Number

Home Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Chapter*

Mobile or Home Phone*

Work Phone

Email

T-Shirt Size (Unisex)*

Small Medium Large X-Large 2XL 3XL 4XL

Are you a Chapter Officer*

Yes No

Chapter Officer Position

Roommate Information
TSEA requires double occupancy of rooms. In the event that a delegate does not have a roommate within their chapter attending the R.A., the TSEA office will attempt to find a roommate from another chapter.

Do you need a room?*

Yes No

Would you like to be in a cabin?

Yes No

Great! The cabins at Fall Creek Falls are lovely. We will do our best to accommodate your request. Please select which size cabin you desire and enter any names of roommates you prefer.

Which size cabin?

3 bed cabin 5 bed cabin

Cabin Roommate 1

First Name

Last Name

Cabin Roommate 2

First Name

Last Name

Cabin Roommate 3

First Name

Last Name

Cabin Roommate 4

First Name

Last Name

Cabin Roommate 5

First Name

Last Name

Do you have a specific Roommate request?

Yes No

Roommate's Name

First Name

Last Name

Roommate's Chapter

Roommate's TSEA Member ID (Last 4 of SS#)

If available / known

Roommate's Mobile or Home Phone

Roommate's Work Phone

Roommate's Email

Are they a Chapter Officer / TEAM-PAC / TSEA Board Member?

Yes No

Chapter Officer Position

Roommate's Home Address

Address Line 1

Address Line 2

City

State

ZIP Code

Comments / Special Needs for Room or Special Dietary Needs

TSEA will attempt to arrange for any special needs of our delegates. Any special arrangements or needs should be listed in the above text box. Note: All rooms are non-smoking. Anyone violating this policy will not receive travel reimbursement.

Arrival Date & Time (Estimated)*

:

Will you be arriving on a Chapter bus/van?

Yes No

In the event you need to cancel your registration, call TSEA no later than May 30, 2024, or your chapter may be charged for the room cost from Fundraising dollars. (After May 30 we can only accept changes not cancellations.) Do you understand and agree to this?*

Yes No

Anderson
Appalachian
Campbell/Scott
Caney Fork
CHAD
Cumberland Plateau
David Crockett
Davidson
ETSU
Fall Creek Falls
Fayette
Foothills
Forked Deer
French Broad
Giles/Lincoln
Greene
Hamilton
Hatchie River
Highland Rim
Hiwassee
Knox/UT
Lakeway
Marion
Maury/Marshall
MHE
Morgan
Norris Lake
Northeast
Pioneer
Reelfoot
Roane
Rutherford
Shelby
Smoky Mountain
South Forty
Southwest
Sycamore
Tealeaf
Three Rivers
Tims Ford
TWS
Upper Cumberland
Volunteer
Warioto
Wayne
WHBC
Williamson

Anderson
Appalachian
Campbell/Scott
Caney Fork
CHAD
Cumberland Plateau
David Crockett
Davidson
ETSU
Fall Creek Falls
Fayette
Foothills
Forked Deer
French Broad
Giles/Lincoln
Greene
Hamilton
Hatchie River
Highland Rim
Hiwassee
Knox/UT
Lakeway
Marion
Maury/Marshall
MHE
Morgan
Norris Lake
Northeast
Pioneer
Reelfoot
Roane
Rutherford
Shelby
Smoky Mountain
South Forty
Southwest
Sycamore
Tealeaf
Three Rivers
Tims Ford
TWS
Upper Cumberland
Volunteer
Warioto
Wayne
WHBC
Williamson

TSEA 2024 R.A. Registration Form