FANTASTIC VOYAGE. The Florida A&M University National Alumni Association Metro-Atlanta Chapter presents

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1 The Florida A&M University National Alumni Association presents FANTASTIC VOYAGE LEAVE: Friday, March 23, 4:30 a.m.* RETURN: Saturday, March 24, 7:00 p.m.* COST: $150 per person **PAYMENT Money order, cashier's check, METHOD: credit card (no personal checks) REGISTRATION PAYMENT/DEADLINE: Saturday, March 2, 2012 * Tentative ** Online payments accepted at ONLY 50 SLOTS AVAILABLE! Parents are welcome! Payment and signed liability waiver must accompany registration form in order to secure slot. Fee includes transportation, hotel, meals, and t-shirt. For additional information, call (404) 523-FAMU or visit NO REFUNDS UNLESS TRIP IS CANCELLED. NO EXCEPTIONS.

2 FLORIDA A&M UNIVERSITY NATIONAL ALUMNI ASSOCIATION Scholarship Application The Metro-Atlanta chapter of the Florida A&M University National Alumni Association is a non-profit organization. For over 30 years, it has served as the official representative of FAMU in the Atlanta area. Each year, the association awards scholarships to metro Atlanta high school students who will attend FAMU. These scholarships are non-renewable and start at $1000. ELIGIBILITY Metro Atlanta high school senior, enrolling at FAMU for the fall semester Minimum SAT score of 1500 and/or ACT score of 20 Minimum 2.5 (4.0 scale) grade point average Completed application package DOCUMENTS TO BE SUBMITTED Application form Official, sealed copy of high school transcript Copy of SAT and/or ACT test scores Three letters of recommendation (cannot use a relative) Essay outlining Why I Selected FAMU To Further My Education (min. 250 words) Passport-size color photo (plain background, no group photos) FAMU acceptance letter (if available) ADDITIONAL REQUIREMENTS Participation in extra-curricular activities Involvement in civic/community activities Personal interview with Alumni panel Application packages must be RECEIVED by the Scholarship Committee no later than March 5, Incomplete submissions will not be considered. Send application documents to: FAMU Nat l Alumni Assoc.: Attention: Scholarship Committee P.O. Box Atlanta, GA Personal interviews will be held on Saturday, March 17, 2012 and scheduled by invitation only. Scholarship recipients will be presented at the Alumni Jazz Brunch on April 14, Scholarship awards will be sent to the recipients in the Fall Semester upon confirmation of matriculation at the University. For additional information or to download the application, visit

3 FLORIDA A&M UNIVERSITY NATIONAL ALUMNI ASSOCIATION Student Scholarship Application Name Mailing Address Telephone Number(s) Address Parent(s)/Guardian High School Attended Year & Month of Graduation Grade Point Average SAT Score ACT Score Extra-Curricular Activities Civic/Community Activities Applied to FAMU? Yes No If yes, Date of Acceptance (Please attach a copy of Acceptance Letter) My signature below attests that, to the best of my knowledge, the information provided in this application is correct and true. Furthermore, I release the contents of the enclosed application packet to the of the FAMU Alumni Association. Student Signature Date

4 FLORIDA A&M UNIVERSITY METRO ATLANTA ALUMNI CHAPTER Fantastic Voyage Registration Form Leave: Friday, March 23, 2012 at 4:30am Return: Saturday, March 24, 2012 at 7:00pm Arrival/Departure Location: Kroger s at 3425 Cascade Road, Atlanta, GA ALL PAYMENTS ARE DUE BY FRIDAY, MARCH 2, 2012 For more information, visit or call (404) 523-FAMU Student Gender M F Parent(s)/Guardian Attending Y N Address City State Zip Student Cell Home Phone Parent Cell Parent Cell High School Grade: Roommate Preference: Preferences are not guaranteed. Spouses or parents accompanying students will be automatically assigned together T-Shirt: Each registrant will receive one t-shirt. Below, indicate t-shirt size and total quantity. Additional t- shirts are available for $10.00 each. S M L XL XXL XXXL Payment Information: Note: Payments will be refunded ONLY if the trip is cancelled. No exceptions. Registrants: x $ = $ (1 t-shirt included) Add l t-shirts: x $10.00 = $ S M L XL XXL XXXL TOTAL AMOUNT DUE = $ Make cashier s check or money order payable to FAMU Metro Atlanta Chapter and send with completed registration form and signed liability waiver to: FAMU Metro Atlanta Chapter P.O. Box Atlanta, GA To register and pay online, visit

5 FAMU NATIONAL ALUMNI ASSOCIATION METRO ATLANTA CHAPTER PERMISSION SLIP AND WAIVER OF LIABILITY I request that (Student s name-please PRINT) be allowed to participate in the Fantastic Voyage trip, sponsored by the Florida A&M University National Alumni Association Metro Atlanta Chapter on (date) to (location) and as described in further detail by the accompanying flyer. If any emergency medical procedures or treatment are required during the trip, I consent to the Alumni Association representatives taking, arranging for, or consenting to the procedures or treatment in his/her or their discretion. In the case of an emergency please notify: Name Phone # Cell# Relationship Name of Insurance Phone # Member Name Member ID Group # Physician s Name Phone # If I can not be reached please contact at least one of the following individuals: Name Phone# Cell# Name Phone# Cell# I agree to release, indemnify, waive and hold harmless the FAMU National Alumni Association Metro-Atlanta Chapter (hereinafter Alumni Association ) their members, heirs, executors, administrators, agents, assigns and related National Organization from and forever promise not to sue them on any and all claims, demands, rights, causes of action, liabilities, losses, damages, costs and expenses (including reasonable attorneys fees), whether known or unknown, that I, any other parent or guardian of the above-named student, or the student may have or may allege to have against the Alumni Association and its members or which may have been brought against the Alumni association and its members arising out of or in manner relating to the student s participation in the Alumni sponsored event, including but not limited to the rendering of emergency medical procedures or treatment. Note this form must be signed by the student if the student is 18 years or older. Name of Student (PLEASE PRINT) Signature of Student Date Name of Parent/Guardian (PLEASE PRINT) Signature of Parent/Guardian Date