Registration Form
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Email *
Full Name - Male
Please list the name of the  Dad, Uncle, Grandfather, Mentor who's attending the event with the young lady
Full Name - Female
Please list the name of the daughter, niece, grand daughter etc. who's attending the event.
# of individuals attending event
Non- Participant
Attending the event as a family member of a daughter, niece, grand daughter etc. participating in the event.
# of non-program participants attending event
PHOTO RELEASE
 *
I hereby grant the permission to Phi Beta Sigma Fraternity Inc. Delta Omicron Sigma Chapter use my likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.

I understand and agree that all photos will become the property of the  Phi Beta Sigma Fraternity Inc. Delta Omicron Sigma Chapter.

I hereby irrevocably authorize the Phi Beta Sigma Fraternity Inc. Delta Omicron Sigma Chapter to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, I waive any right to inspect or approve the finished product wherein my likeness appears. 

I hereby hold harmless, release, and forever discharge the Phi Beta Sigma Fraternity Inc. Delta Omicron Sigma Chapter  from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf or on behalf of my estate have or may have by reason of this authorization.

I HAVE READ AND UNDERSTAND THE ABOVE PHOTO RELEASE. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENTS/GUARDIANS AS EVIDENCED BY ACKNOWLEDGING YES OR NO BELOW.

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