Social Registration Form

Social Registration Form Social Registration Form Sponsoring Organization [Required] Valid input: - Select only one choice. - must select a value. Page 1 of 6 Social Registration Form

[ ] ALLIES @ Ole Miss [ ] Advocates for Student [ ] Departmental [ ] Disabilities Association [ ] African Caribbean Association [ ] Alpha Epsilon Delta Pre-Med Pre-Dent Society [ ] Alpha Kappa Alpha Sorority, Inc.-Theta Psi Chapter [ ] Alpha Kappa Psi [ ] Alpha Lambda Delta Honor Society [ ] Alpha Omicron Pi [ ] Alpha Phi Alpha Fraternity Incorporated [ ] Alpha Phi Omega - Epsilon Omega Chapter [ ] Alpha Psi Omega [ ] Alpha Tau Omega [ ] Alpha Theta Chapter of Beta Alpha Psi [ ] American Association of Pharmaceutical Scientists - UM Student Chapter [ ] American Association of University Women [ ] American Constitution Society [ ] American Institute of Chemical Engineers [ ] American Pharmacists Association-Academy of Student Pharmacists [ ] American Society of Civil Engineers [ ] American Society of Health-System Pharmacists [ ] American Society of Mechanical Engineers [ ] Amnesty International [ ] Arnold Air Society [ ] Artist Series [ ] Associated Student Body [ ] Association of Information Technology Profressionals [ ] Badminton Club [ ] Baseball Team [ ] Beta Beta Beta Biological Honors Society [ ] Beta Theta Pi [ ] Beta Upsilon Chi [ ] Black Law Students Association [ ] Black Social Sciences Collective [ ] Black Student Union [ ] CHEERS to the Designated Driver [ ] CW's 105 [ ] Campus Liberals [ ] Campus for Clean Energy [ ] Chi Omega [ ] Christian Legal Society [ ] Christian Pharmacy Fellowship International [ ] College Republicans [ ] Colleges Against Cancer [ ] Colonel Reb Foundation [ ] Commission on the Status of Women [ ] Cultural Connections Club [ ] Cultural Connections Mentorship Program [ ] Cultural Connections Program [ ] Cultural Passport Program [ ] Default [ ] Delta Delta Delta [ ] Delta Gamma [ ] Delta Psi [ ] Delta Sigma Theta Sorority, Inc.-Lambda Sigma Chapter [ ] Delta Theta Phi [ ] Department of Campus Recreation [ ] Diverse Diggers Vball Team [ ] ECOM - Episcopal Church at Ole Miss [ ] Engineers Without Borders - USA, Ole Miss Chapter [ ] Environmental Law Society at the University of Mississippi School of Law [ ] Epiphany Campus Ministry [ ] Eta Kappa Nu [ ] Eta Sigma Phi, Lambda Chapter [ ] Exchange at Ole Miss [ ] Facility Operations Team [ ] Feral University Rebel Rescuers [ ] Friendship Association of Chinese Students and Scholars [ ] Gamma Beta Phi [ ] Gamma Phi Delta Christian Fraternity, Inc [ ] Gay-Straight Alliance [ ] Gertrude C. Ford Center for the Performing Arts [ ] Graduate English Feminist Theory Reading Circle [ ] Graduate Student Council [ ] Greek Recruitment [ ] Green Dot Page 2 of 6 Social Registration Form

[ ] Hand Band [ ] Hear My Voice [ ] History Department [ ] Hope for Africa [ ] IMAGE [ ] Indian Students Association [ ] Institute of Electrical and Electronics Engineers [ ] Institute of Transportation Engineers Student Chapter [ ] Intensive English Program [ ] Interfraternity Council [ ] International Ladies Club [ ] International Learning Exchange [ ] JWJS [ ] Kappa Alpha Order [ ] Kappa Alpha Theta [ ] Kappa Delta [ ] Kappa Epsilon [ ] Kappa Kappa Gamma [ ] Kappa Omicron Nu [ ] Kappa Psi Pharmaceutical Fraternity, Beta Rho Chapter UM [ ] Kappa Sigma [ ] Korean Students Association [ ] Lambda Pi Chapter of Kappa Alpha Psi Fraternity, Incorporated [ ] Lambda Sigma [ ] Latin American Student Organziation [ ] Law Association for Women [ ] Law School [ ] Law School Student Body [ ] Lecture Series [ ] Legal Studies Student Association [ ] Lets Talk [ ] Lott Leadership Institute and Public Policy Leadership [ ] Luckyday Residential College [ ] Men of Excellence [ ] Mississippi Sports Law Review [ ] Model United Nations [ ] Mortar Board [ ] Music Education Ole Miss [ ] Muslim Students Association [ ] National Association for the Advancement of Colored People [ ] National Community Pharmacists Association [ ] National Pan-Hellenic Council [ ] National Society of Black Engineers [ ] National Society of Collegiate Scholars [ ] National Student Speech Language Hearing Association [ ] NewsWatch [ ] Ninjutsu Club [ ] OMCC [ ] OUTlaw [ ] Office of Health Promotion [ ] Office of International Programs [ ] Ole Miss A Cappella [ ] Ole Miss Ambassadors [ ] Ole Miss Ambassadors of Southern Hospitality [ ] Ole Miss Army ROTC [ ] Ole Miss Brazilian Jiu-Jitsu Club [ ] Ole Miss Chapter of International Justice Mission [ ] Ole Miss Club Tennis Team [ ] Ole Miss Events Calendar [ ] Ole Miss Film Society [ ] Ole Miss Gamer's Association [ ] Ole Miss German Club [ ] Ole Miss Green Initiative [ ] Ole Miss Gun Safety Club [ ] Ole Miss Habitat for Humanity [ ] Ole Miss Hockey Club [ ] Ole Miss Iaido & Battodo Club [ ] Ole Miss Karate Club [ ] Ole Miss Law Partners [ ] Ole Miss MBA Class of 2011 [ ] Ole Miss MENC Collegiate Chapter [ ] Ole Miss Marketing Organization [ ] Ole Miss Men's Lacrosse [ ] Ole Miss Men's Soccer [ ] Ole Miss Mocha Club [ ] Ole Miss Mock Trial Association [ ] Ole Miss Naval Recruiting Officer Training Corps [ ] Ole Miss Outdoors Page 3 of 6 Social Registration Form

[ ] Ole Miss Paintball Club [ ] Ole Miss Pre-Law Society [ ] Ole Miss Print Club [ ] Ole Miss Quiz Bowl Team [ ] Ole Miss Rugby Football Club [ ] Ole Miss Russian Club [ ] Ole Miss Student Dance [ ] Ole Miss Students for a Green Campus [ ] Ole Miss Transfer Leadership Organization [ ] Ole Miss Women's Lacrosse [ ] Olemiss Competitive Chess Team [ ] Omega Phi Alpha [ ] Omicron Delta Kappa [ ] One Book One Community [ ] Order of Omega [ ] Orientation Class of 2015 [ ] Orientation Leaders [ ] PI Beta Phi [ ] Panhellenic Council [ ] Patterson School of Accountancy [ ] Peer Health Educators [ ] Pentecostal Youth Fellowship [ ] Phi Alpha Honor Society [ ] Phi Delta Chi [ ] Phi Delta Theta [ ] Phi Eta Sigma [ ] Phi Kappa Psi [ ] Phi Kappa Tau [ ] Phi Mu [ ] Phi Mu Alpha Sinfonia [ ] Phi Sigma Tau [ ] Pi Kappa Alpha [ ] Pi Mu Epsilon - Mississippi Alpha Chapter [ ] Provost Scholar Program [ ] Psi Chi The International Honor Society in Psychology [ ] Psychological Services Center [ ] Public Interest Law Foundation [ ] Rebel Runners Club [ ] Rebel Sculpture Society [ ] Rebels for Christ [ ] Rebels for United Way [ ] Reformed University Fellowship [ ] Residential Housing Association [ ] Russkii Klub [ ] Sigma Alpha Epsilon [ ] Sigma Alpha Iota [ ] Sigma Alpha Lambda [ ] Sigma Chi [ ] Sigma Gamma Rho (Xi Zeta Chapter) [ ] Sigma Nu [ ] Sigma Phi Epsilon [ ] Sigma Phi Lambda [ ] Sigma Pi- Beta Mu Chapter [ ] Sigma Tau Delta [ ] Sistah Speak [ ] Social Work Students Association [ ] Society of Professional Journalists [ ] Society of Women Engineers [ ] Sport Clubs [ ] Student Advisory Board, Journalism School [ ] Student Affairs Directors [ ] Student Alumni Council [ ] Student Art Association [ ] Student Health Law Association [ ] Student Members of the American Chemical Society [ ] Student National Pharmaceutical Association [ ] Student Personnel Association [ ] Student Programming Board [ ] Student-Athlete Advisory Committee [ ] Students for a Safe Ride [ ] Study Abroad Office [ ] Survey Portal [ ] TOMS Shoes Ole Miss [ ] Taiwanese Student Association [ ] Tau Beta Pi Engineering Honor Society - MS Beta Chapter [ ] Tau Eta Chapter of Zeta Phi Beta Sorority, INC [ ] The Big Event [ ] The Cardinal Club Page 4 of 6 Social Registration Form

[ ] The Chancellor's Leadership Class [ ] The Columns Society [ ] The Daily Mississippian [ ] The Eta Beta Chapter Phi Beta Sigma Fraternity, Inc. [ ] The Federalist Society for Law and Public Policy Studies [ ] The Fellowship of Christian Athletes [ ] The Gorove Society of International Law [ ] The National Civil Engineering Honor Society [ ] The Office of the Dean of Students [ ] The Ole Miss [ ] The Ole Miss Diving Club [ ] The University of Mississippi Amateur Radio Club [ ] The University of Mississippi Box Office [ ] The University of Mississippi Gospel Choir [ ] The University of Mississippi Jewish Community [ ] Theta Alpha Kappa - Religious Studies Honor Society [ ] UM Homeless Outreach [ ] UM Medicinal Chemistry Journal Club [ ] UM Recovery Community [ ] Undergraduate Black Law Students Association [ ] University Lions Club [ ] University of Mississippi Adult and Nontraditional Student Organization [ ] University of Mississippi Anime Club [ ] University of Mississippi Association of Black Journalists [ ] University of Mississippi Colony of Iota Phi Theta, Fraternity Inc. [ ] University of Mississippi Criminal Justice Association [ ] University of Mississippi Fashion Board [ ] University of Mississippi Feminist Majority [ ] University of Mississippi Management Consulting Club [ ] University of Mississippi Mud Daubers [ ] University of Mississippi Student Vegetarian Organization [ ] University of Mississippi Vietnamese Student Association [ ] Volunteer Services [ ] Web Test Site [ ] Who's Who Among Students in American Universities & Colleges [ ] Women's Association at the University of Mississippi [ ] Women's Ultimate Frisbee Team [ ] World Wide Rebels [ ] Young Americans for Liberty [ ] Young Life If departmental what department do you represent? Date of Event [Required] Time Frame [Required] Location [Required] Purpose of Event [Required] * Parade, rally, and race events must provide route and obtain permission from OPD and UPD * Party, greek show, and concerts must provide name and contact information of security company. [ ] Parade [ ] Rally [ ] Race [ ] Fundraiser [ ] Party [ ] Greek Show [ ] Other Description [Required] Please give a brief description of the event and what it entails. i.e. # of participants, details on the type, goals, and outcomes. Page 5 of 6 Social Registration Form

Security Company [Required] If not applicable please put "n/a" Security Company Phone # [Required] Security Company Email Will there be live music? [Required] [ ] YES [ ] NO Name of performer/dj Will there be alcohol at the event? [Required] [ ] Yes [ ] No Sober Observer Sober observers must be identified for events that will have alcohol. a. SOBER OBSERVER Must be a member of the sponsoring organization. Must remain sober throughout the event. Must be willing to be a point of contact for the organization and the University in case of emergency throughout the event Sober Observer Name Sober Observer's Cell Phone # Organization Officer associated with the set up of the event [Required] Officer Email [Required] Officer Phone # [Required] Organization President President Email President Phone Terms and Conditions Checkbox [Required] You as representing officer of your organization agree to hold your event to the standards of the University Creed, University policies, and abide by state, local, and federal laws. Valid input: - Select only one choice. [ ] I Agree Page 6 of 6 Social Registration Form