Get Omega Psi Phi Form 9a 20

Form 9A-20 OMEGA PSI PHI FRATERNITY INC. ACKNOWLEDGEMENT AND INDEMNIFICATION AGREEMENT Name of Applicant or Member Print Social Security Number Applicant Street Address City/State/Zip Code Chapter Name CHAPTER LOCATION I certify that I am aware of the fact that Omega Psi Phi Fraternity Inc. expressly prohibits and vehemently opposes the use of physical or mental harassment/hazing in any of its activities. I understand that hazing includes but is not limited to physical violence such as paddling slapping pushing of another s body by use of any object device or hand strenuous exercises forced inducement or the causing of another to consume any food liquid or other substance pouring sprinkling or covering of another s body with any substance threatening or causing another to be placed in fear of receiving any physical injury such as the activities listed above and generally any act or acts which would cause any person any humiliation embarrassment or physical harm* I agree that I shall report any acts of hazing or attempted hazing promptly to the Membership Selection Team in writing with a copy to the District Representative or directly to the District Representatives. I understand that failure to render said report shall serve as sufficient cause for my dismissal from the Fraternity. I understand that the Omega Psi Phi Fraternity Inc is a non-profit corporation incorporated in the District of Columbia and having its domicile and principal place of business in Decatur Georgia* employ persons or firms to act on behalf of the Fraternity. I understand that as member or potential member of Omega Psi Phi Fraternity Inc* I am not an agent of the organization* Further I understand that I have no authority whatsoever to enter into any agreements whether oral or written that would obligate Omega Psi Phi Fraternity Inc* in any way. conditions contained herein* Accordingly I do hereby release and indemnify the Omega Psi Phi Fraternity Inc* against any claim loss damage or expense caused by me for actions which subject the Fraternity s assets to judgments for losses damages or expenses awarded by a court or agreed upon in settlement negotiations. I further bind my legal representatives heirs successors and assigns to the terms and conditions of this agreement. this document on his behalf* Further I certify that I enter into these stipulations and agreements knowingly freely and without duress or coercion of any kind* I further certify that my date of birth is. Witness my hand this day of 20 city/state Signature Applicant or Member Signature Notary Public Signature Parent/Legal Guardian if member Is under 21 years of age Commission expires Date Parent s Address Friendship is Essential to the Soul Seal. I understand that hazing includes but is not limited to physical violence such as paddling slapping pushing of another s body by use of any object device or hand strenuous exercises forced inducement or the causing of another to consume any food liquid or other substance pouring sprinkling or covering of another s body with any substance threatening or causing another to be placed in fear of receiving any physical injury such as the activities listed above and generally any act or acts which would cause any person any humiliation embarrassment or physical harm* I agree that I shall report any acts of hazing or attempted hazing promptly to the Membership Selection Team in writing with a copy to the District Representative or directly to the District Representatives. I understand that failure to render said report shall serve as sufficient cause for my dismissal from the Fraternity.