Chapter Registration Form

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OMEGA PSI PHI FRATERNITY, INC
65th Eighth District Meeting
Colorado Springs, CO April 10th – 13th 2014
“Home of the Rocky Mountain Ques”
Host Chapter: Xi Pi Chapter
Location: The Double Tree Hotel, Colorado Springs, CO
District Marshal: Brother Brett Britton
Welcome to the 65th Eighth District Meeting. The 2014 District meeting promises to be the best ever, with
various presentations, tutorials, networking events and activities for your family. This will provide all
participants an opportunity to exchange ideas with brothers across the district and learn about innovative
solutions covering multiple aspects of fraternity operations. If you have any questions, contact Brother Brett
Britton (District Marshal) at (719)445-6642 or RockyMountainQues@gmail.com.
REGISTRATION:
The Registration site for the Eighth District Meeting is now open and can be accessed by going to
The Eighth District web page (under “BROTHERS and 65th DISTRICT MEETING”). On-line
registration closes March 31, 2014 at midnight. Any brother wishing to register after that will have to register
on-site. Meals and rooms cannot be guaranteed for late or on site registrants. All brothers are required to
register for the 2014 District Meeting and pay the appropriate fees in order to participate in any aspect of the
meeting. http://omegapsiphi8d.org/login/65th-district-meeting/
Registration Fees:
Graduate Fee: Early Registration thru December 31, 2013 $125.00
Basic Registration January 1, 2014 thru February 28, 2014 $145.00
Late Registration March 1, 2014 thru March 31, 2014 $165.00
On-Site Registration $200.00
No Registration payment needed for Members Initiated after March 2013
Undergraduate Fee: Early Registration thru December 31, 2013 $80.00
Basic Registration January 1, 2014 thru February 28, 2014 $90.00
Late Registration March 1, 2014 thru March 31, 2014 $105.00
On-Site Registration $120.00
No Registration payment needed for Members Initiated after March 2013
NOTE: The no registration fee only applies to brothers who were initiated after the close of the 64th District
Meeting in Albuquerque, New Mexico April 2013. You must complete a registration form and send it in.
The Double Tree Hotel, 1775 East Cheyenne Mountain Blvd, Colorado Springs, CO 80906
Reserve your room now for the 65th Eighth District meeting! Rooms have been blocked for the Eighth District’s
meeting attendees with the following Room Rates: $89.00/Single and $99.00/Double. The hotel will honor
these rates until Saturday, March 1, 2014.
To reserve your room, you must call 719-576-8900 and reference Omega Psi Phi. To visit the hotel’s web
site for additional accommodation information, please go to http://Double
Tree3.hilton.com/en/hotels/colorado/Double Tree-by-hilton-hotel-colorado-springs-COSP-DT/index.html
65th Eighth District Meeting 2014 - Forms
OMEGA PSI PHI FRATERNITY, INC
65th Eighth District Meeting
Colorado Springs, CO April 10th – 13th 2014
Individual Registration Form
Name
FIRST
MIDDLE INITIAL
00
CONTROL # (FROM FINANCIAL CARD)
LAST
Home Address:
STREET
Home Telephone # (
)
CITY
Work Telephone # (
Chapter
STATE
)
ZIP
E-mail
Location
CHECK ONE: VOTING STATUS:
CHAPTER DELEGATE**
NON-VOTING MEMBER
** Delegate must also complete FROM 36 CREDENTIALS by no later than (March 10, 2014).
REGISTRATION FEES
Note: Fees for extra meal and event tickets are shown below.
List # desired here
1
_________________
List Amount(s) here
Basic registration fee (includes District reports, Souvenir Booklet & Gift
Founders Banquet, Undergraduate Luncheon, Prayer Breakfast,
Step Show, Dance, Talent Hunt)
Fee Depends on Submission and Pay Date.
$
Golf Outing TBA
$ _______________
Founders Banquet (Black-Tie) Ticket @ $35.00 each extra ticket
________________
$
Undergraduate Luncheon Ticket @ $20.00 each extra ticket
$
8th District Meeting Prayer Breakfast @ $20.00 each extra ticket
$
8th District Step Show @ $15.00 each extra ticket
$
All White Party/Dance @ $15.00 each extra ticket
$ _______________
Grand Total
$
There is an optional Omega discount cost of $20 (Actual Price is $35) to registered District Meeting Brothers only for the R & B
concert slated on the evening of 10 April 2014. This concert will be hosted by the Xi Pi Uplift Foundation and is not a part of the
Meeting registration packet. Please reserve your ticket(s) early as there will be limited seating to this open to the public event.
R & B Concert Ticket @ $20.00 each extra ticket
(Registered Brothers)
$
R & B Concert Ticket @ $35.00 each extra ticket
(Non Registered Brothers)
$
PLEASE NOTE REGISTRATION FEES AND ON-SITE TICKET PRICES:
Early Registration thru December 31, 2013 (Graduate $125.00 – Undergraduate $80.00)
Basic Registration January 1, 2014 thru February 28, 2014 (Graduate $145.00 – Undergraduate $90.00)
Late Registration March 1, 2014 thru March 31, 2014 (Graduate $165.00 – Undergraduate $105.00)
Onsite Registration (Graduate $200.00 – Undergraduate $125.00)
Founders Banquet Ticket*
$45.00
65th Eighth District Meeting 2014 - Forms
Undergraduate Luncheon Ticket*
Step Show Ticket*
All White Party/ Dance Ticket*
$25.00
$20.00
$20.00
* The host chapter does not guarantee that tickets will be available for sale on-site.
If you are paying by personal check, cashier’s check, chapter checks or money order, please staple check to this form.
RECIEPTS WILL BE EMAILED TO YOU.
This form can be mailed to ATTN: Brett Britton, District Marshal
Xi Pi Chapter, Omega Psi Phi Fraternity, Inc.
8381 Tallman Rd, Peyton, CO 80831
by March 10, 2014
65th Eighth District Meeting 2014 - Forms
OMEGA PSI PHI FRATERNITY, INC
65th Eighth District Meeting
Colorado Springs, CO April 10th – 13th 2014
Chapter Registration Form
(For Attending the District Meeting)
Registration fee for all chapters, graduate and undergraduate: $75.00
Chapter: _________________________________________________________
Status: _____Graduate
_____Undergraduate
Mailing Address: _________________________________________________
City: _______________________ State: _____________________ Zip Code: ___________
Basileus: ___________________________________________________
Vice Basileus: _______________________________________________
Keeper of Records and Seal: ___________________________________
Keeper of Finance: ___________________________________________
Chapter Registration will be received through March 10, 2014
After March 10, 2014 Chapter Registrations will be processed on-site
Acceptable forms of payment are as follows:
Personal checks, money orders, cashier’s checks, or Traveler’s checks made payable to:
Eighth District, Omega Psi Phi Fraternity, Inc.
ATTN: Osuman Issaka, DKRS
3220 Farnam Street
Apt #2517
Omaha, NE 68131
65th Eighth District Meeting 2014 - Forms
# of
Delegate
Votes
Submitted
OMEGA PSI PHI FRATERNITY, INC.
65th Eighth District Meeting
Form 36
DELEGATE FORM
Chapter
Name
Control #
Chapter
Type
Name
Last, First, Middle Initial
Today’s
Date
Total #
Of Votes
Email Address
(used to contact delegate if needed)
Delegate Type
Please note that only ONE Delegate can vote twice IF the chapter is eligible per distance requirements. These requirements are clearly defined in the
8th District Bylaws. PRIMARY delegates can cast votes. ALTERNATE Delegates can replace a primary delegate with chapter authorization.
Chapters should NOT designate more delegates than they have votes. Doing so may prevent their delegates from being able to vote until the
discrepancy is resolved.
TO WHOM IT MAY CONCERN, This is to certify that the Brothers listed above are bona fide members of our chapter and are in good
financial standing as defined in the 8th District Bylaws. They have been duly elected to serve as a Delegate or Alternate Delegate to the
65th Eighth District Meeting as indicated above and are to have all the rights and privileges pertaining thereto.
Fraternally,
Basileus Name (Please Print)
Keeper of Records and Seal Name
(Please Print)
Important Note:
This form is to be RECEIVED by the DKRS
NO LATER THAN March 10, 2014
Email a copy to 8thDistrictKRS@oppf.org
___
__
__
Basileus Signature _________________________
Keeper of Records and Seal
Signature ________________________________
65th Eighth District Meeting - Attn: Form 36
Bro. Osuman Issaka, DKRS
8th District Keeper of Records & Seal
IN ORDER FOR CHAPTERS TO HAVE VOTING PRIVILEGES DURING ANY CONCLAVE OR DISTRICT MEETING, THE CHAPTER'S ANNUAL
INSURANCE & CEF OBLIGATIONS MUST BE PAID TO INTERNATIONAL HEADQUARTERS PRIOR TO THAT MEETING.
A CURRENT COPY OF FORM 50 SHOULD ACCOMPANY THIS FORM.
65th Eighth District Meeting 2014 - Forms
OMEGA PSI PHI FRATERNITY, INC
65th Eighth District Meeting
Colorado Springs, CO April 10th – 13th 2014
DISTRICT SOUVENIR BOOK AND PRICES
PAPER SIZE 8 ½X 11
Advertisement Size
Full Page
½ Page
¼ Page
Business Card
Color
Black & White
$150
$100.00
$100
$75
$75
$50
$30
$25
Patron $10
Inside Front Cover $250
Inside Rear Cover $250
Outside Rear Cover $300
All money and ads must be received by March 10, 2014. Send camera-ready copy of ad as you wish it displayed in the
book. Pictures must be good quality (prefer digital copy). Pictures may be color or black and white. Note: Please
provide a copy of your ad in a JPG or PNG format and email your ad to Rockymountainques@gmail.com (which is the
preferred method) in addition, you may send CD’s. You may also mail the ad to the address below. A $25.00 Set-Up fee
will be charged if ad is not properly formatted. Please return the advertisement layout sheet with the bottom coupon and
cashier’s check, certified check or money order made payable to: Xi Pi Chapter.
Mail To:
ATTN: Brett Britton, District Marshal
Xi Pi Chapter, Omega Psi Phi Fraternity, Inc.
8381 Tallman Rd, Peyton, CO 80831
You are authorized to publish our (amount of space) ______________ page advertisement in the 2014 Souvenir Booklet
to be printed for the 65th Eighth District Meeting of the Omega Psi Phi Fraternity, Inc., to be held April 10-13, 2013 in
Colorado Springs, CO. Enclosed you will find a payment to: Xi Pi Chapter, in the amount of $____________ for the
advertisement and a copy/layout of my/our ad.
Name: _______________________________________________ Date: __________________________
Address: _____________________________________________________________________________
City: ________________________________________State: ___________ Zip Code: _______________
Home Phone: ______________________Work Phone: ______________________ Fax: ______________
Name of Contact Person (Print) ________________________________ Email: _____________________
Signature: ____________________________
A receipt will be mailed by Xi Pi Chapter
Thanks for your patronage
65th Eighth District Meeting 2014 - Forms
OMEGA PSI PHI FRATERNITY, INC
65th Eighth District Meeting
Colorado Springs, CO April 10th – 13th 2014
VENDOR FORM
Please print or type – Use black ink only!
Contact Person: ________________________________________ Vendor ID#: _____________________________
Vendor Name: _________________________________________________________________________________
Address: ______________________________________________________________________________________
City: ___________________________________ State: ____________ Zip Code: ___________________________
Telephone Number: ____________________________________________________________________________
Number of Booths: _________________________________ @ 150.00 per booth = $ ________________________
Number of Extra Tables: _________________________________ @ 50.00 per table = $ _____________________
Booths and tables issued on a first come first served basis. Vending booth area is to be a standard 10x10 space
with one table provided for each booth space purchased. They will be available for sales beginning Thursday,
October 24, 2013 at 4:00 p.m. through Sunday, March 10, 2014. Payments are to be in the form of a
cashier’s check or money order. VENDORS WILL NOT BE ALLOWED TO SELL WITHOUT
PAYMENT BEING RECEIVED IN ADVANCE. This form must be accompanied by payment of the
required fee and a copy of the current license issued by Omega Psi Phi Fraternity, Inc. Failure to comply with
each requirement will result in a denial of the privilege to sell at scheduled meetings and functions hosted by
Eighth District of the Omega Psi Phi Fraternity Inc. Any vendor selling Omega paraphernalia that depicts
the canine image or likeness will be closed and prohibited from further sales at the function. Additionally,
the vendor will not be refunded any of the fees paid to the Eighth District of Omega Psi Phi Fraternity, Inc.
Payment must be in the form of a Cashier’s Check or Money Order Only and made Payable to: Xi Pi Chapter
Mail To:
ATTN: Brett Britton, District Marshal
Xi Pi Chapter, Omega Psi Phi Fraternity, Inc.
8381 Tallman Rd, Peyton, CO 80831
Note: This form must be received on or before March 10, 2014.
65th Eighth District Meeting 2014 - Forms
OMEGA PSI PHI FRATERNITY, INC
65th Eighth District Meeting
Colorado Springs, CO April 10th – 13th 2014
VENDOR NEEDS ANALYSIS
VENDOR NAME: __________________________________________________________________________
Will you require electricity? YES ____________ NO ___________
*Number of 10X10 booths you will require? ________________________________________
*Number of tables you will require? ________________________________________
Number of credentials you will require? ____________________________________
Number of chairs you will require? ________________________________________
Additional requirements?
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Note: This form must be received on or before Mar 10, 2014.
ATTN: Brett Britton, District Marshal
Xi Pi Chapter, Omega Psi Phi Fraternity, Inc.
8381 Tallman Rd, Peyton, CO 80831
*Please note that every vendor purchasing a “booth” will be provided a space that is 10’ x 10’ for every booth
purchased. One table will be provided for every booth purchased. A vendor needing additional tables may
supply their own or rent them for 50.00 each as supplies allow. Any vendor needing more than 10’x 10’ of
space must purchase additional adjacent booths. Adjacent space cannot be guaranteed if the space is not
reserved prior to the March 10, 2014.
65th Eighth District Meeting 2014 - Forms
OMEGA PSI PHI FRATERNITY, INC
65th Eighth District Meeting
Colorado Springs, CO April 10th – 13th 2014
STEP SHOW FORM
Please print or type - Use black ink only! Contact Person:
Contact Person: ________________________________________________________________________________________
Chapter Name: _________________________________________________________________________________________
Address: ______________________________________________________________________________________________
City: ________________________________________________State: _________________ Zip Code: __________________
Telephone Number: ___________________________ (Home)
________________________________ (cell)
All Step Show participants must be financial members of Omega Psi Phi Fraternity, Inc. and a financial member of the
participating chapter. Any team that exhibits any vulgar language and/or canine references, dressed inappropriately
or behaving in a manner that is not representative of member of Omega Psi Phi Fraternity, Inc., (as deemed by the
host chapter will be automatically disqualified and asked to end their performance immediately. All performances
should be limited to ten (10) minutes. For Men of Omega: A first place trophy, team name plate added to the Eighth
District Competition trophy, and the opportunity to return the following year to defend their title will be given to the first
place winner. Prizes will be awarded to category winners
BROTHER’S NAME(S)
CONTROL #
CHAPTER
____________________________________ __________________________ _________________________________
____________________________________ __________________________ _________________________________
____________________________________ __________________________ _________________________________
____________________________________ __________________________ _________________________________
____________________________________ __________________________ _________________________________
____________________________________ __________________________ _________________________________
____________________________________ __________________________ _________________________________
____________________________________ __________________________ _________________________________
____________________________________ __________________________ _________________________________
Note: This form must be received on or before March 10, 2014.
ATTN: Brett Britton, District Marshal
Xi Pi Chapter, Omega Psi Phi Fraternity, Inc.
8381 Tallman Rd, Peyton, CO 80831
Step Show Form
Or Email: Rockymountainques@gmail.com
65th Eighth District Meeting 2014 - Forms
OMEGA PSI PHI FRATERNITY, INC
65th Eighth District Meeting
Colorado Springs, CO April 10th – 13th 2014
QUETTE REGISTRATION FORM
If your spouse or significant other will be attending the district meeting please complete this form and
return it to Xi Pi Chapter by March 10, 2014. This will allow sufficient time to plan a slate of activities
for our Quettes.
Note: With sufficient attendance of Quettes, plan tours may include the United States Air Force
Academy, The United States Olympic Committee Training Center, North American Air Defense
Command (NORAD), etc.
Brother’s Name:___________________________________________
Spouse/Significant Other Name:_______________________________
Mailing Address:___________________________________________
City/State/Zip Code:___________________________________________________
Chapter:__________________________________________________
Your Email Address:________________________________________
Phone #: __________________________________________________
Please mail or email completed form to:
ATTN: Brett Britton, District Marshal
Xi Pi Chapter, Omega Psi Phi Fraternity, Inc.
8381 Tallman Rd, Peyton, CO 80831
Email: Rockymountainques@gmail.com
Please let us know as soon as possible so we may plan this support for you.
65th Eighth District Meeting 2014 - Forms
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