2018 North Carolina State Leadership Conference Sigma Beta...

2018 North Carolina State Leadership Conference Sigma Beta Club Registration Packet

Durham, North Carolina September 28 – 29, 2018

2018 NORTH CAROLINA STATE SIGMA BETA CLUB

LEADERSHIP CONFERENCE SEPTEMBER 28 – 29, 2018

DURHAM, NORTH CAROLINA

Corporate Headquarters • William E.Doar, Jr. Building • 145 Kennedy Street, N.W. • Washington, D.C. 20011

Office of

Mose Dorsey

North Carolina State Director

3412 Secretariat Way

Raleigh, North Carolina 27614

Phone: (919) 971-7599

August 10, 2018

Sigma Beta Club Members, Parents, and Guardians:

I would like to welcome you to the 2018 North Carolina State Conference of the Phi Beta Sigma

Fraternity, Inc. hosted in the beautiful city of Durham. Your State Sigma Beta Club Coordinator and team

has planned a great conference with workshops and events to promote and celebrate culture, athletics,

social and educational needs of conference attendees.

Please be aware that there will be no onsite registration this year. All Sigma Beta Club members and

advisors are encouraged to submit the completed conference packet before September 15, 2018. Please

carefully read through the packet and submit all forms by the posted deadline.

We are fortunate this year to be able to hold workshops and several conference events on the illustrious

campus of North Carolina Central University. We have planned a conference centered around the HBCU

experience that will include attending the NCCU vs FAMU football game, campus tours and other

activities.

We are excited to offer a weekend of activities for the Sigma Beta Club members and we hope that it is

one in which they will return home energized and prepared to be leaders in their schools and their

communities! Sigma Beta Club Coordinators and Advisors, please distribute this packet to your club

members as soon as possible. If you have any questions, please feel free to contact me. Thank you and I

look forward to seeing you in September!

Brother Mose Dorsey

Phi Beta Sigma Fraternity, Inc

North Carolina State Director




TENTATIVE SCHEDULE OF EVENTS

North Carolina Central vs Florida A&M University Football Game

Take this opportunity to enjoy this great HBCU rivalry. This is an opportunity to represent in our blue and white, promote brotherhood and fellowship with one another. We have secured a group rate of $10 per ticket. Please note that this price is not included in the cost of registration. Tickets may be purchased on the website or mailed in with your registration. Please note that we will have to purchase all tickets 2 weeks prior to the conference to secure the group rate.




2018 North Carolina State Conference Hotel Millennium Durham

2800 Campus Walk Avenue

Durham, NC 27705

Phone: (919) 383-8575

Website: www.millenniumhotels.com

RESERVATION INFORMATION

The room rates are $99.00 per night for single or double plus state/local taxes. Reservations may be made under the group block “Phi Beta Sigma” by calling the hotel directly at (800)633-5379. A credit card is required to guarantee a reservation. Rooms not cancelled by 4pm on the day of arrival will be charged to the individual’s credit card.

RESERVATION CUT-OFF DATE

The cut-off date is August 29, 2018. Any rooms NOT reserved will be released for general sale and

reservations and the group rate will only be accepted on a space available basis. Please make plans to

reserve your room immediately.

You’ll find Millennium Durham minutes away from Duke University Hospital and Duke University- and

an easy drive to charming downtown Durham. In addition to 316 suites and rooms, our hotel has all of the

modern comforts you’d expect. When it’s time to dine, you can enjoy authentic Italian or enjoy a snack

and cocktail by the fireplace at Bel Gusto or American cuisine at The Varsity Lounge and Grill. Other

amenities include our Ask Alfred Children Program, free WI-FI, on-site parking, fitness center, over

16,000 square feet of event and meeting space and much more! Stay at Millennium Durham, where a

warm welcome waits!

http://www.millenniumhotels.com/




Parental/Guardian Consent Form and Medical Release (page 1)

Please print or type application Date:

Participant’s Name: Age:

Parent/Guardian’s Name:

Home Address:

City: State: Zip Code:

Email:

Phone Number: home cell

“I/ We give permission for

our son, , an active member of

Chapter Sigma Beta Club, who is registered and who will participate in the 2018 North

Carolina State Sigma Beta Club Leadership Conference which will be held in Durham,

North Carolina.

In addition, I/we release and waive, and further agree to indemnify, hold harmless the National

Sigma Beta Club Foundation, Inc. and Phi Beta Sigma Fraternity, Inc., its Officers and

Membership, Agents or Representatives, as well as SBC Advisors and/or Parents/guardians, from

and against, any claims or claim to have, known or unknown, directly or indirectly, from any lost,

damage, or injury arising out of, during or in connection with the participant/Sigma Beta Club

Member as a registrant of the 2018 North Carolina State Leadership Conference, and/or any

conference activities and travel to and from the 2018 Sigma Beta Club Leadership Conference, or

the rendering of or administering of emergency medical procedures or treatment and/or EMS and

Hospital related medical care.”

This form must be maintained by the Sigma Beta Club Advisor/Coordinator during the 2018 North Carolina

State Sigma Beta Club Leadership Conference for emergency purposes and proof of parental/guardian consent.





I give my permission for my son to participate in the following

events and activities during the 2018 NC State Sigma Beta Club Leadership Conference (please

initial):

Archery

Basketball

Boating

Community Service Project

Culture Arts & Music Museums

Hiking/Binocular

Horseback Riding

Nature Journaling

Obstacle Course

Rope Course

Swimming

Wall/Tower Climbing/Repelling Walls

Water Testing

Youth Conservation Corp/Internship Seminar

I do not wish to have my child participate in any physical activity

during the 2018 NC State SBC Leadership Conference.

Parent/Guardian Signature(s):

Print:

Sign: Date:

Print:

Sign: Date:







My/Our child has Insurance/Medical coverage with:

Insurance Company/Medical Provider:

Policy/Medical Number: Effective from to

Known Prescribed/off Counter Medication:

Known Allergies:

Doctor/Physician’s Name:

Office Address:

Office Telephone No.: Fax Number:

Parent/Guardian Signature(s):

Print: (required)

Sign: Date:

Print:

Sign: Date:

Subscribe and sworn before me DAY OF , 20 .

Notary Signature:

Notary Public, State of My Commission Expire






There will be no onsite registration. Registration fees can be mailed or paid via PayPal on the website at:

. igma o nc.o g. Please use the PayPal Friends and Family option if you have a PayPal account. This

will eliminate additional fees. Please be sure to indicate the name and chapter of each person you are

registering. Online registration will close on September 24, 2018. All mailed forms must be postmarked by

September 12, 2018. Please note that we will need to advance order football tickets 2 weeks prior to conference.

Make checks payable to: Phi Beta Sigma Fraternity, Inc. Mail Order Form and Check by September 12, 2018 to:

Brother JaQuan Thompson

4509 Chapel Ridge Drive

Greensboro, NC 27405

CONFERENCE REGISTRATION FORM – SBC MEMBER

PLEASE PRINT OR TYPE

SBC Member’s Name:

Parent/Guardian’s Information


Home Address:


Email:

Phone Number: Alternate Phone Number:

Chapter Information

Chapter Name:

Chapter Address:

Chapter Coordinator:


REGISTRATION FEES:

Sigma Beta Club Member: $50.00 Officer (Position: )

NCCU vs FAMU Football Tickets: $10.00

Total Enclosed

http://www.sigmasofnc.org/




There will be no onsite registration. Registration fees can be mailed or paid via PayPal on the website at:

. igma o nc.o g. Please use the PayPal Friends and Family option if you have a PayPal account. This

will eliminate additional fees. Please be sure to indicate the name and chapter of each person you are

registering. Online registration will close on September 24, 2018. All mailed forms must be postmarked by

September 12, 2018. Please note that we will need to advance order football tickets 2 weeks prior to conference.

Make checks payable to: Phi Beta Sigma Fraternity, Inc. Mail Order Form and Check by September 12, 2018 to:

Brother JaQuan Thompson

4509 Chapel Ridge Drive

Greensboro, NC 27405

CONFERENCE REGISTRATION FORM – SBC COORDINATOR/ADVISORS

PLEASE PRINT OR TYPE


Home Address:


Email:


Chapter Information

Chapter Name:

Chapter Coordinator:

Chapter Address:

Chapter President:


REGISTRATION FEES:

SBC Chapter Coordinator - $100.00 Life Member

NCCU vs FAMU Football Tickets: $10.00 JTF Hall of Fame Member

Total Enclosed

http://www.sigmasofnc.org/




Emergency Contact Information

Please print or type application: Date:

SBC Member Name:

In Case of Emergency, please contact: (both sections are required to be filled):

Name: Relationship:

Home Address:


Email:

Phone Number: Home:

Work:

Cell:

Name: Relationship:

Home Address:


Email:

Phone Number: Home:

Work:

Cell:






MEDIA PARENTAL CONSENT AND RELEASE FORM FOR

(SBC MEMBER)

This AGREEMENT (hereinafter referred to as the “Agreement”) is made effective this day of

, 20 by and between ,

Parent/Guardian of , Sigma Beta Club Member, whose

home address is (address),

(city), (state) (zip code) (hereinafter referred to as “Parent/Guardian”) and

the National Sigma Beta Club Foundation, Inc., located at 145 Kennedy Street, Washington, D.C. 20011/3313

Government Street, Baton Rouge, LA 70806 (hereinafter referred to as the “the Foundation”).

WITNESSETH:

In consideration of the respective covenants contained herein, the parties hereto, intending to be legally bound

hereby, agree as follows:

The Parent/Guardian understands that during the Conference, photographs and video footage may be taken

during the conference, and he/she/they hereby grant to the Foundation, its Photographers, Videographer,

advertising and marketing agency, licensees and producers or publishers of its promotional materials, and their

successors and assigns, the right to use, publish and copyright pictures and likeness, in whole or part, including

alterations, modifications, derivations and composites thereof, of the Sigma Beta Club member during the 2018

NC State Sigma Beta Club Leadership Conference held in Durham, North Carolina during the weekend of

September 28 - 29, 2018, which may occur for the purpose of advertising and promotion of the Foundation

throughout the world forever. This right shall include the right to combine the Sigma Beta Club member’s

likeness with others or other forms of promotional materials must conform to the standards of the National Sigma

Beta Club Foundation consistent with its Code of Ethics for Club members and must not depict the Club member

in a lewd, provocative, distasteful or negative manner.

I, , hereby warrant that I am the [Parent or Guardian]

of , a minor, and I have full authority to authorize the above

Release which I have read and approved, I hereby release and agree to indemnify the Foundation, the Fraternity,

its Board and officers, Chapters and Advisors, and its Photographers, Videographer, advertising and marketing

agency, licensees, producers publishers, and successors and assigns, from and against any and all liability arising

out of the exercise of the rights granted by the above Parental Release Form for Sigma Beta Club member.

IN WITNESS WHEREOF, the parties hereto have executed this Agreement on the day and year first above

written,

AGREED TO AND ACCEPTED:

BY PARENT/GUARDIAN BY SIGMA BETA CLUB MEMBER:

(an authorized signatory) (an authorized signatory if over 18 years old)

The Sigma Beta Club member must sign this form, in addition to his parent or guardian, if he reached or will

reach the age of eighteen (18) years old by the time of the 2018 NC State Sigma Beta Club Leadership

Conference.






CODE OF CONDUCT AND EXPECTATIONS

The following is the Code of Conduct and Expectations for Sigma Beta Club members during the 2018

North Carolina State Sigma Beta Club Leadership Conference which is held in Durham, North

Carolina from September 28 – 29, 2018.

I , a Sigma Beta Club Member, acknowledges and accept

the following conduct and expectations during this State Sigma Beta Club Leadership Conference:

• Attend all activities,

• Behave appropriately at all times,

• Respect hotel and/or all other facilities and the personal property of others. Repair costs for damages

incurred to property will be billed to the Advisor and the individual responsible for such damages,

• Be responsible for personal belongings,

• Adhere to all curfews,

• Observe quiet times,

• Stay with assigned groups and Sigma Beta Club Coordinator/Advisors,

• Use appropriate language at all times,

• Follow all conference procedures,

• Do not disrupt or interferes with conference programming,

• Do not leave a program or the facility without permission of a Sigma Beta Club Advisor or authorized

staff,

• Wear shirts and shoes inside all buildings at all times,

• Before or during checkout, guests must pay for all incidental charges,

• Abide by all local, state and federal laws,

• Refrain from possession, selling, and/or use of alcoholic beverages, tobacco products, and illegal drugs

or substances OR being present where individuals are using alcohol, tobacco products and/or any illegal

substances,

• Report any unusual verbal, physical and/or sexual misconduct or any other conduct that is contrary to

the policies and procedure adopted by the National Sigma Beta Club Foundation.

• If there are any illegal activities being conducted during this Conference, immediately report these

findings to the any Sigma Beta Club Coordinator and/or Advisor.

• Respect the dignity, diversity of cultures, backgrounds and family customs of all individual Sigma Beta

Club Members.

SIGMA BETA CLUB ADVISORS AND ADULT CHAPERONES ARE RESPONSIBLE FOR ENFORCING

THE CONDUCT AND EXPECTATIONS AS STATED HEREIN. VIOLATORS MAY BE ASKED TO

LEAVE OR SENT HOME AT THEIR OWN EXPENSE. THESE RULES ARE NOT SUBJECT TO

INTERPRETATION, AND EACH CLUB AND INDIVIDUAL IS EXPECTED TO FOLLOW THEM

WITHOUT EXCEPTION. OUR PRIMARY CONSIDERATION IS TO PROVIDE A SAFE, SECURE

ENVIRONMENT FOR ALL SIGMA BETA CLUB MEMBERS.

Parent/Guardian Signature Sigma Beta Club Member Signature

Coordinator/Advisor Signature Date

2018 STATE CONFERENCE SIGMA BETA OF THE YEAR APPLICATION

2018 NORTH CAROLINA STATE CONFERENCE

September 28 & 29, 2018 – Durham, North Carolina

Millennium Hotel Durham – 2800 Campus Walk Avenue – Durham, NC 27705

SB Name: Position: GPA:

Sponsoring Alumni Chapter:

Chapter Coordinator/Advisor:

Contact:

Mailing Address:

City: State: NC Zip:

Telephone: Email:

Please list all other positions held in the club, extracurricular activities, awards and honors. Also

include any plans for after high school: (attach additional sheet if needed). Also, please list all

conferences attended in the past year.

Along with the application a portfolio must be completed. Your portfolio must include the

following:

▪ Picture of the applicant

▪ Pictures of applicant in everyday life accompanied with descriptions. (family, friends, recreation,

school)

▪ Pictures of various activities that the applicant takes part in with the Sigma Beta Club

accompanied by descriptions.

▪ Pictures of various activities that the applicant takes part in other than the Sigma Beta Club

accompanied by descriptions.

▪ A written essay explaining why you would be the best recipient of this award.

500-words (High School) • 300-words (Middle School) • 100-words (Elementary School)

Note: Your portfolio will be judged on essay, neatness and information provided.

Return by September 8, 2018 to:

Brother Robert L. Wilder, Jr.

100 Stepping Stone Trail

Jacksonville, NC 28546

Email: [email protected]

mailto:[email protected]

2018 STATE CONFERENCE SIGMA BETA SCHOLARS APPLICATION

2018 NORTH CAROLINA STATE CONFERENCE

September 28 & 29, 2018 – Durham, North Carolina

Millennium Hotel Durham – 2800 Campus Walk Avenue – Durham, NC 27705

Name: Grade Level:

Chapter Name:

Mailing Address:

City: State: NC Zip:

Telephone: Email:

Elementary School Members Only:

❑ Were you on the A/B Honor Roll Last School Year? YES NO

❑ Were you on the all As Honor Roll Last School Year? YES NO

What is your cumulative GPA?

❑ 3.0-3.9 GPA (weighted) or 4.0 + GPA (weighted)

Middle School Members Only:





High School Members Only:





The Sigma Scholar Award is designed to recognize those Sigma Beta Club members who exhibit

the best in academic achievement. The recognition of this award is based on the criteria above.

Elementary and Middle school applicants must submit a copy of their last report card. High

school applicants must submit an official transcript.

Return by September 8, 2018 to:

Brother Robert L. Wilder, Jr.

100 Stepping Stone Trail

Jacksonville, NC 28546

Email: [email protected]

mailto:[email protected]

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