CONCLAVE 2021 REGISTRATION KIT - AUGUST 3 - 8, 2021 MYRTLE BEACH CONVENTION CENTER - Phi Beta Sigma

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CONCLAVE 2021 REGISTRATION KIT - AUGUST 3 - 8, 2021 MYRTLE BEACH CONVENTION CENTER - Phi Beta Sigma
CONCLAVE 2021 REGISTRATION KIT
AUGUST 3 - 8, 2021           MYRTLE BEACH CONVENTION CENTER
                             Myrtle Beach, South Carolina

      phibetasigma1914.org
CONCLAVE 2021 REGISTRATION KIT - AUGUST 3 - 8, 2021 MYRTLE BEACH CONVENTION CENTER - Phi Beta Sigma
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    HON. MICHEAL CRISTAL          BRO. BEN VEREEN                BRO. BILL DUKE               BRO. KEITH PERRIN
      Conclave Chairman                                       Honorary Co-Chairmen

Phi Beta Sigma Fraternity, Inc. will convene at one of the most popular beach destinations in the South for the
organization’s biennial international convention. Bustling with history, culture, and personality, Myrtle Beach, South
Carolina boasts 60 miles of pristine beaches, sophisticated dining and entertainment options, and world-class
golf. Conclave 2021 is sure to provide Sigma Brothers and guests with an extraordinary conference experience.
REGISTER TODAY for your opportunity to be a part of another milestone moment in Phi Beta Sigma’s history!

GENERAL REGISTRATION INFORMATION
In preparation for your participation at Conclave 2021 – Myrtle Beach, please review the important registration
details below.

There is no on-site registration at Conclave. Registration must be purchased in advance by JUNE 11, 2021.
Conclave registration includes all plenary sessions, workshops, education sessions, corporate training/networking
events, Sigma Marketplace, the Opening Ceremony, President’s Reception, Breakfast with the Candidates, the
Miss Phi Beta Sigma Pageant, the International Step Show Competition, International Awards Luncheon, the
Grand Orchid Ball, plus additional receptions and networking events. Please note that the Life Members and
Brotherhood Luncheon and the Phi Beta Sigma Federal Credit Union Breakfast ARE NOT included in the
registration fee. You may purchase these event tickets with your Conclave registration. Tickets will not be sold
at the door.

          EARLY BIRD                               REGULAR                                   LATE
    Aug. 10, 2020 - Nov. 30, 2020         Dec. 1, 2020 - Mar. 31, 2021            Apr. 1, 2021 - Jun. 11, 2021

    Alumni: $525                          Alumni: $625                           Alumni: $725

    Collegiate: $425                      Collegiate: $525                       Collegiate: $625

    Guest: $475                           Guest: $575                            Guest: $675

    DSC: $475                             DSC: $575                              DSC: $675
                                See the new Registration Refund Policy on page 4.

                                      CONCLAVE 2021 • MYRTLE BEACH, S.C.
CONCLAVE 2021 REGISTRATION KIT - AUGUST 3 - 8, 2021 MYRTLE BEACH CONVENTION CENTER - Phi Beta Sigma
RESERVING YOUR HOTEL
Phi Beta Sigma Fraternity members MUST first register for Conclave 2021 in order to reserve hotel rooms at the
discounted Conclave rate. Once registration payment is complete, your registration confirmation will include the
reservation link to participating room block hotels. Reservations can then be made in BluPrint. There are a limited
number of discounted rooms. Brothers are encouraged to book early before rooms sell out.

SHERATON MYRTLE BEACH CONVENTION CENTER HOTEL
                                                                 STAY AT THE HEADQUARTERS HOTEL ADJACENT TO THE
(HEADQUARTERS HOTEL)                                             CONVENTION CENTER AND CONCLAVE EVENTS.
2101 North Oak Street,
Myrtle Beach, South Carolina 29577
Phone: 843-918-5000

Connected to the Myrtle Beach Convention Center
and just two blocks from the scenic Myrtle Beach
Boardwalk, the Sheraton Myrtle Beach offers the
finest amenities including spacious rooms with
plush beds, premium movie channels, and floor-
to-ceiling windows. Visit Vidalia’s for fresh South
Carolina cuisine or unwind at the Lobby Bar.
Located in downtown Myrtle Beach, the Sheraton
is just steps from the ocean, a short drive to the
restaurants and attractions at Broadway at the
Beach, and just 10 minutes from Myrtle Beach
International Airport.

RATES:
Standard King or Double: $169.00 per night

DOUBLETREE RESORT MYRTLE BEACH OCEANFRONT
3200 South Ocean Boulevard,
                                                                 STAY AT THE HOTEL DIRECTLY ON THE BEACH!
Myrtle Beach, South Carolina 29577
Phone: 843-315-7100

Located on the south end of Ocean Boulevard and
adjacent to Myrtle Beach State Park, this beautiful
oceanfront Hilton resort features stylish guest
rooms and comfortable amenities. Guest rooms
feature private balconies overlooking the hotel’s
private beach and exterior corridors with ocean
views. Enjoy oceanfront dining at Ocean Blue, the
Southern Tide Bar & Grill, or grab a bite from The
Market Grab ‘N Go while awaiting complimentary
shuttle service to the Myrtle Beach Convention
Center. The Doubletree is conveniently located
near the Myrtle Beach International Airport and
less than 5 miles to the convention center.

RATES:
Oceanview Single or Double: $199.00 per night (Resort Fee included in Rate)

                                                                          PHI BETA SIGMA FRATERNITY, INCORPORATED     3
CONCLAVE 2021 REGISTRATION KIT - AUGUST 3 - 8, 2021 MYRTLE BEACH CONVENTION CENTER - Phi Beta Sigma
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                                                 REGISTRATION                   COVID-19                          the transferor and transferee
    PAYMENT OPTIONS                              CONFIRMATION                   REFUND POLICY                     before the transfer can be
                                                                                                                  processed.
    The preferred method of                      Register on line or by         Our concerns over all
    registration fee payment is                  email to receive an            COVID-19 healthcare issues
                                                 electronic confirmation        are certainly as magnified as     VOTING
    the BluPrint Database System.                receipt. Confirmations for     yours; we care for each           INFORMATION
    Cashier/bank checks, all major               mailed registrations will be   and every possible attendee       Conclave 2021 participants
                                                 sent to the address listed     at Conclave Myrtle Beach!!        designated as the primary
    credit cards, and money orders               on the registration form.      We do not want concerns           delegate and/or alternate
    are accepted. Purchase orders                Please contact the Finance     about the possible need           delegate representing
                                                 Department at                  for reimbursement of              their respective chapter
    are not accepted. Please note                registration@                  registration fees to prevent      and other qualified voting
    that all credit card payments will           phibetasigma1914.org           you from taking advantage         members, must provide
                                                 if your confirmation           of our great registration
    be charged a 4% processing                                                                                    official confirmation of their
                                                 receipt is not received.       rates. Should the current         eligibility status from the
    fee. Additionally, funds can be                                             novel coronavirus pandemic        International Headquarters.
    remitted from your Phi Beta                  REGISTRATION                   continue, or a future             Each delegate must
                                                                                COVID-19 outbreak make            complete the Delegate
    Sigma Federal Credit Union                   MATERIALS
                                                                                it inadvisable or impossible      Certification Section on
    (PBSFCU) account for registration            All Conclave materials will    for you and your family to        the Registration Form.
                                                 be available for pick-up       travel to Conclave 2021
    payments.        Please   contact            beginning at 8:00 am on        in Myrtle Beach, you will
                                                                                                                  SPECIAL
    the PBSFCU. Your Conclave                    Tuesday, August 3 at the       receive a refund of your
                                                 2021 Conclave Registration     Conclave registration and         NEEDS
    Registration       Form    MUST              Desk at the Myrtle Beach       guest registration fees,          All Plenary Sessions and
    accompany the payment.                       Convention Center.             minus the cost of the 2021        meal functions will provide
                                                 Pre-registered Brothers and    Conclave gift item.               special seating for Brothers
                                                 guests MUST provide their      COVID-19 related refund
    The cut off postmark date for all            Conclave 2021 Registration     requests must be received
                                                                                                                  and guests with special
                                                                                                                  needs.
    mail-in registrations is JUNE 11,            Confirmation and a             in writing at the international
                                                 government issued photo        headquarters no later than
    2021. Mail in registrations post-                                                                             • For mobility assistance
                                                 ID to receive your Conclave    June 11, 2021.                      throughout Conclave,
    marked after June 11, 2021 ARE               materials.                                                         registrants may rent
                                                                                We will refund your fees
    NOT guaranteed full registration                                                                                wheelchairs or
                                                                                within a 30-day period              mobility scooters
    kits and conference gifts, subject           REGISTRATION
                                                                                of time. We experienced             from numerous
                                                 REFUND POLICY                  the same need to process
    to pre-ordered stock.                                                                                           providers in
                                                 Should the current novel       registration refunds when           Myrtle Beach.
                                                 coronavirus pandemic no        Sigma had to cancel our
    Mail Registration Form with                  longer be a threat to the      Zeta Centennial 2.0               • Meals. For special
                                                                                                                    meals (vegetarian,
    Cashier/Bank Check                           registrants of the Conclave    activities. We were able to
                                                                                                                    gluten-free), indicate
                                                 2021 in Myrtle Beach, SC       refund fees within 30 days
    or Money Order Payment to:                                                  of cancelling that event.           requirements with
                                                 we still have a cancellation
                                                 policy that has always been                                        your registration in
    PHI BETA SIGMA FRATERNITY, INC.                                                                                 the space provided.
                                                 in place and will continue     REGISTRATION
    Attn: Finance Department                     with Conclave 2021             TRANSFER                          • Guest Room Accessibility.
    145 Kennedy Street, NW                       registrations. Attendees                                           Be sure to notify your
                                                 that must cancel their         Registration may be
    Washington, D.C. 20011                                                                                          hotel of any accessibility
                                                 registration for reasons not   transferred between
                                                                                                                    requirements when
                                                 related to the coronavirus     financial members through
                                                                                                                    making your hotel
                                                 will receive a refund of       JUNE 11, 2021. Current
    Email Registration Form with Credit Card                                                                        reservation.
                                                 their/guest fees, minus        registration rates apply.
    Authorization Payment to:                                                   Additional registration           • Check the individual
    accountsreceivable                           the service fee $150.00;
                                                 this covers the cost of the    fees will be due from the           hotel website for
    @phibetasigma1914.org                                                       transferee if the registration      individual hotel
                                                 2021 Conclave gift item.
    REGISTRATION FORMS WITHOUT                   Non- coronavirus related       is transferred after a rate         guest amenities.
                                                 registration refund requests   increase deadline. Guest
    PAYMENT WILL NOT BE ACCEPTED
                                                 must be received in            registration may also be
                                                 writing at the international   transfered under these
                                                 headquarters no later than     terms. Written authorization
                                                 MARCH 31, 2021.                must be received from both

                                               CONCLAVE 2021 • MYRTLE BEACH, S.C.
CONCLAVE 2021 REGISTRATION KIT - AUGUST 3 - 8, 2021 MYRTLE BEACH CONVENTION CENTER - Phi Beta Sigma
SCHEDULE AT-A-GLANCE
    P R E L I M I N ARY

                          PHI BETA SIGMA FRATERNITY, INCORPORATED   5
CONCLAVE 2021 REGISTRATION KIT - AUGUST 3 - 8, 2021 MYRTLE BEACH CONVENTION CENTER - Phi Beta Sigma
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                                                                                  Conclave events and dates are subject
                                                                                   to change. Make sure you check the
                                                                                       Phi Beta Sigma App for updated
                                                                                                  schedule information.

    MONDAY, AUGUST 2, 2021
    • VOLUNTEER ORIENTATION		                                                          2:00PM – 4:00PM

    TUESDAY, AUGUST 3, 2021
    • REGISTRATION		                                                                   8:00AM – 5:00PM
    • COLLEGIATE ADVISORS UNIVERSITY		                                                 8:00AM – 12:00PM
    • WALTER M. CLARKE PROFESSIONAL AND LEADERSHIP DEVELOPMENT INSTITUTE
      - EDUCATION BLOCK 1		                                                            10:00AM – 10:50AM
      - EDUCATION BLOCK 2		                                                            11:00AM – 11:50AM
    • LUNCH ON YOUR OWN		                                                              12:00PM – 1:30PM
    • CCDP TRAINING – PART 1		                                                         1:00PM – 5:00PM
    • HIGHER EDUCATION TOWN HALL FORUM		                                               1:30PM – 3:30PM
    • WALTER M. CLARKE PROFESSIONAL AND LEADERSHIP DEVELOPMENT INSTITUTE
      - EDUCATION BLOCK 3		                                                            1:30PM – 3:00PM
      - EDUCATION BLOCK 4		                                                            3:30PM – 4:00PM
    • SIGMA MARKETPLACE RIBBON CUTTING		                                               2:30PM – 6:00PM
    • GENERAL BOARD MEETING		                                                          3:00PM – 5:00PM
    • GENERAL BOARD DINNER		                                                           6:30PM – 9:00PM
    • HOSPITALITY		                                                                    8:00PM – 11:00PM

    WEDNESDAY, AUGUST 4, 2021
    • REGISTRATION		                                                                   7:00AM – 5:00PM
    • ANNUAL DEMETRIUS C. NEWTON GOLF CLASSIC		                                        7:00AM – 2:30PM
    • SIGMA MARKETPLACE		                                                              8:00AM – 6:00PM
    • INTERNATIONAL HEADQUARTERS OFFICE		                                              8:00AM – 5:00PM
    • PAST PRESIDENTS’ BREAKFAST		                                                     8:00AM – 9:30AM
    • CCDP TRAINING-PART 2		                                                           8:00AM – 12:00PM
    • FIRST-TIME ATTENDEES ORIENTATION		                                               9:00AM – 10:00AM
    • INTERNATIONAL PROGRAMS WORKSHOPS:
      - SOCIAL ACTION: NAACP		                                                         8:00AM – 8:50AM
      - SOCIAL ACTION: MARCH OF DIMES		                                                8:00AM – 8:50AM
    • INTERNATIONAL PROGRAMS WORKSHOPS:
      - SOCIAL ACTION: NAACP		                                                         9:00AM – 9:50AM
      - SOCIAL ACTION: MARCH OF DIMES		                                                9:00AM – 9:50AM

                                             CONCLAVE 2021 • MYRTLE BEACH, S.C.
CONCLAVE 2021 REGISTRATION KIT - AUGUST 3 - 8, 2021 MYRTLE BEACH CONVENTION CENTER - Phi Beta Sigma
• INTERNATIONAL PROGRAMS WORKSHOPS:
  - EDUCATION: TBD		                          8:00AM – 8:50AM
  - EDUCATION: TBD		                          8:00AM – 8:50AM
• NOBLE WORKSHOP		                            9:00AM – 10:00AM
• COMMITTEE MEETINGS:
		 AUDIT		                                    10:00AM – 11:00AM
		 AWARDS & STANDARDS		                       10:00AM – 11:00AM
		 CREDENTIALS		                              10:00AM – 11:00AM
		 DSC		                                      10:00AM – 12:00PM
		 ELECTIONS		                                10:00AM – 12:00PM
		 GRIEVANCE		                                10:00AM – 12:00PM
		 HONORARY MEMBERS		                         10:00AM – 12:00PM
		 INTERNATIONAL PROGRAMS		                   10:00AM – 12:00PM
		 LAW & REVISIONS		                          10:00AM – 12:00PM
		 NOMINATIONS		                              10:00AM – 12:00PM
		 RESOLUTIONS		                              10:00AM – 12:00PM
		 SIGMA-ZETA RELATIONS		                     10:00AM – 12:00PM
• DEBATE COMPETITION		                        10:00AM – 12:00PM
• INTERNATIONAL PROGRAMS WORKSHOP:
  - BIGGER AND BETTER BUSINESS: TBD		         10:00AM – 12:00PM
  - BIGGER AND BETTER BUSINESS: TBD		         10:00AM – 12:00PM
• SIGMA BETA CLUB ADVISOR WORKSHOP 1		        10:00AM – 12:00PM
• SIGMA CONCLAVE STEM CHALLENGE		             10:00AM – 12:00PM
• PROFESSIONAL DEVELOPMENT WORKSHOPS		        11:00AM – 11:50PM
• DEBATE COMPETITION: FINAL		                 12:00PM – 1:00PM
• LUNCH ON YOUR OWN		                         12:00PM – 2:00PM
• CHAPTER DEVELOPMENT WORKSHOPS		             2:00PM – 3:00PM
• PARLIAMENTARY PROCEDURE WORKSHOP		          2:00PM – 3:00PM
• NUL – YOUNG PROFESSIONALS WORKSHOP		        2:00PM – 3:00PM
• MODEL CHAPTER INTERVIEWS 		                 2:00PM – 5:00PM
• ORATORICAL COMPETITION		                    2:00PM – 4:00PM
• SIGMA BETA CLUB ADVISOR WORKSHOP 2		        2:00PM – 4:00PM
• SELC BOLD CONVERSATION ON LEADERSHIP		      4:00PM – 6:00PM
• VIP HOLDING ROOM 		                         5:30PM – 6:30PM
• OPENING CEREMONY		                          6:30PM – 9:00PM
• PRESIDENT’S RECEPTION		                     9:00PM – 11:00PM

                                       PHI BETA SIGMA FRATERNITY, INCORPORATED   7
CONCLAVE 2021 REGISTRATION KIT - AUGUST 3 - 8, 2021 MYRTLE BEACH CONVENTION CENTER - Phi Beta Sigma
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    • HOSPITALITY		                                                           10:00PM – 12:00AM
    THURSDAY, AUGUST 5, 2021
    • DELEGATE VERIFICATION/VOTING TOOL DISTRIBUTION		                        6:00AM – 9:00AM
      - 7:40AM-8:15AM EASTERN
      - 7:40AM-8:15AM GREAT LAKES
      - 8:20AM-8:40AM GULF COAST
      - 8:20AM-8:40AM SOUTHEASTERN
      - 8:40AM-9:00AM SOUTHERN
      - 8:40AM-9:00AM SOUTHWESTERN
      - 8:40AM-9:00AM WESTERN
    • REGISTRATION		                                                          7:00AM – 5:00PM
    • BREAKFAST WITH THE CANDIDATES		                                         7:00AM – 9:00AM
    • INTERNATIONAL HEADQUARTERS OFFICE		                                     8:00AM – 5:00PM
    • SIGMA MARKETPLACE		                                                     8:00AM – 6:00PM
    • CHAPTER DISPLAYS		                                                      9:00AM – 12:30PM
    • BILLBOARD JACKSON COMPETITION JUDGING		                                 9:00AM – 12:00PM
    • STEP SHOW TEAM MEETING		                                                9:00AM – 10:00AM
    • REGIONAL MEETINGS
      - EASTERN REGION		                                                      10:00AM – 11:30AM
      - GREAT LAKES REGION		                                                  10:00AM – 11:30AM
      - GULF COAST REGION		                                                   10:00AM – 11:30AM
      - SOUTHEASTERN REGION		                                                 10:00AM – 11:30AM
      - SOUTHERN REGION		                                                     10:00AM – 11:30AM
      - SOUTHWESTERN REGION		                                                 10:00AM – 11:30AM
      - WESTERN REGION		                                                      10:00AM – 11:30AM
    • LUNCH ON YOUR OWN		                                                     11:30AM – 12:30PM
    • FIRST LADIES RECEPTION (REGISTERED GUESTS ONLY)		                       11:30AM – 1:00PM
    • COLLEGIATE PIZZA PARTY (COLLEGIANS ONLY)		                              11:30AM – 12:30PM
    • LIFE MEMBERS & BROTHERHOOD LUNCHEON (TICKETED EVENT)		                  11:30AM – 12:30PM
    • MENS’ WEARHOUSE TUXEDO PICK-UP & DROP-OFF		                             12:00PM – 9:00PM
    • PLENARY SESSION I		                                                     1:00PM – 5:30PM
    • HONORARY MEMBER INDUCTION CEREMONY		                                    5:30PM – 6:30PM
    • INTERNATIONAL PROGRAMS WORKSHOP:
      - BIGGER AND BETTER BUSINESS: TBD 		                                    5:30PM – 7:00PM
    • DISTINGUISHED SERVICE CHAPTER MEETING		                                 5:30PM – 7:00PM
    • LARGEST CHAPTERS RECEPTION (INVITED CHAPTERS ONLY)		                    6:00PM – 7:00PM
    • SELC BROTHERHOOD NETWORKING EVENT		                                     7:00PM – 8:00PM

                                         CONCLAVE 2021 • MYRTLE BEACH, S.C.
CONCLAVE 2021 REGISTRATION KIT - AUGUST 3 - 8, 2021 MYRTLE BEACH CONVENTION CENTER - Phi Beta Sigma
• MISS INTERNATIONAL PHI BETA SIGMA PAGEANT		              8:00PM – 9:30PM
• INTERNATIONAL STEP SHOW COMPETITION & PARTY		            9:30PM – 11:00PM
• HOSPITALITY		                                            10:00PM – 12:00AM

FRIDAY, AUGUST 6, 2021
• REGISTRATION		                                           7:00AM – 5:00PM
• INTERNATIONAL HEADQUARTERS OFFICE		                      8:00AM – 5:00PM
• SIGMA MARKETPLACE		                                      8:00AM – 7:00PM
• OMEGA & REDEDICATION CEREMONIES		                        7:00AM – 8:00AM
• PBSFCU ANNUAL BREAKFAST MEETING (TICKETED EVENT)		       8:00AM – 9:00AM
• MENS’ WEARHOUSE TUXEDO PICK-UP & DROP-OFF		              9:00AM – 7:00PM
• PLENARY SESSION II		                                     9:00AM – 11:30AM
• GUEST PROGRAM ROUNDTABLE TALK		                          10:00AM – 11:30AM
• INTERNATIONAL AWARDS LUNCHEON		                          12:00PM – 2:30PM
• LIFE MEMBERS BUSINESS MEETING		                          2:30PM – 4:00PM
• HONORARY MEMBER SUMMIT		                                 3:00PM – 5:00PM
• COMMUNITY SERVICE PROJECT		                              3:00PM – 5:00PM
• ALAIN LEROY LOCKE HONORS CHAPTER 		                      5:30PM – 6:30PM
& DISTINGUISHED SERVICE CHAPTER INDUCTION CEREMONY
• SIGMAS IN HIGHER EDUCATION NETWORKING SOCIAL		           6:00PM – 7:00PM
• DISTINGUISHED SERVICE CHAPTER DINNER (DSC ONLY)		        6:30PM – 8:00PM

SATURDAY, AUGUST 7, 2021
• INTERNATIONAL HEADQUARTERS OFFICE		                      8:00AM – 12:00PM
• PLENARY SESSION III		                                    8:00AM – 12:00PM
• SIGMA MARKETPLACE		                                      8:00AM – 6:00PM
• MENS’ WEARHOUSE TUXEDO DROP-OFF		                        8:00AM – 2:00PM
• IMPACT ONE DONORS RECEPTION		                            12:30PM – 1:30PM
• 3 ON 3 BASKETBALL TOURNAMENT		                           1:00PM – 4:00PM
• ENJOY MYRTLE BEACH!!		                                   1:00PM – UNTIL!!!
• GRAND ORCHID BALL		                                      8:00PM – 1:00AM

SUNDAY, AUGUST 8, 2021
• POST GENERAL BOARD MEETING		                             8:00AM – 9:30AM

                                                    PHI BETA SIGMA FRATERNITY, INCORPORATED   9
REGISTRATION FORM
Greetings!
Register now for Conclave 2021 and save!
Rates increase after the 11/30/20
Early Bird deadline.

 general information                           q      ALUMNI             q    COLLEGIATE                    q      PRIMARY DELEGATE              q     ALTERNATE DELEGATE

Name: ___________________________________________________________________________ Member # ___________________

Address: _____________________________________________________________________________________________________

City: _______________________________________________________________________ State: _______ Zip: ________________

Phone: __________________________________________________________                                                       Please check: q       Home q          Mobile (cell) q         Work

Email: _______________________________________________________________________________________________________
Chapter: __________________________________________________________ Region: ____________________________________
Professional Occupation / Major: _____________________________________________________________________________________
Company / Current University: ______________________________________________________________________________________

 guest information
Name: ______________________________________________________________ Guest of Brother: ___________________________

Address: _____________________________________________________________________________________________________

City: _______________________________________________________________________ State: _______ Zip: ________________

Phone: __________________________________________________________                                                       Please check: q       Home q          Mobile (cell) q         Work

Email: ______________________________________________________________________________________________________
Sorority Affiliation (If Applicable): ______________________________________________________________________________________

 payment information                                                                                                                    Check All That Apply:
Member Registration Amount: $ ________________                                                                                          q First Time Attendee
Guest Registration Amount: $ __________________                              Payment Method Please check:                               q DSC Member
                                                                             q VISA             q DISCOVER                              q Alaine Leroy Locke Honors Chapter
Ticketed Event Amount: $ _____________________
                                                                                                                                        q Gold Life Member
                                                                             q MASTERCARD q AMEX
                                                                                                                                        q Sapphire Life Member
TOTAL REGISTRATION FEES: $ _________________                                                                                            q Platinum Life Member
                                                                                                                                        q Heritage Member
Cardholder Name: ______________________________________________________________
Billing Address: ________________________________________________________________                                                       Ticketed Events:
                                                                                                                                        q Life Members and Brotherhood Luncheon
City, State Zip: _________________________________________________________________                                                          Thursday, August 5, 2021
Credit Card Number: _____________________________________________________________                                                           $50 per ticket # of tickets ______
                                                                                                                                        q Phi Beta Sigma Federal Credit Union Breakfast
Expiration Date: _____________________ CVV#: _______
                                                                                                                                          Friday, August 6, 2021
____________________________________________________ ______________                                                                       $50 per ticket # of tickets ______
Authorized Signature:						Date:                                                                                                        Special Needs Accommodation:
                                                                                                                                        q Hearing Impaired
Note:                                                                                                                                   q I will have a motorized wheelchair or scooter
By signing, you are authorizing Phi Beta Sigma Fraternity, Inc. to charge the agreed amount listed to the credit card provided
herein. You agree to pay for this purchase in accordance with the issuing bank cardholder agreement.                                    Meal Restrictions:
A 4% credit card processing fee will be added to your transaction.                                                                      q Vegetarian
                                                                                                                                        q Gluten-Free
* Preferred method of contacting during conference:                  q   Text q       Email                                             q Food Allergies ________describe

EMERGENCY CONTACT:
Name: _____________________________________________________________________                                                      Relationship: ____________________________
Phone: _____________________________________                              Email: _________________________________________________________________
Phi Beta Sigma Fraternity, Inc. | 145 Kennedy St. NW | Washington, DC 20011

                       www.phibetasigma1914.org
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