Chapter Registration Form

NEW Member Registration Form

2024-2025 Academic Year
Member Registration Process:

There is a three-step process to register for membership. Please remember to complete all three steps for the benefits of full membership.

Step 1: Registration with NSBE Nationals & Payment of $5 National Dues , click here . Login and create a new username and password. (Each member must have their own username (email address) and password. Multiple email addresses may not be used, the system will treat it as a duplicate account. Any issues, please contact membership@nsbe.org ) Select the login link at the top right corner of the page, then enter your login details and follow the steps to submit the payment. This step is required to become a member of the National NSBE Organization.

Step 2: Complete Chapter New Member Registration, including the required Permission Acknowledgement/Release of Liability Waiver. This allows you to become a member of and participate in our local chapter.

Step 3: Payment of Local Chapter Dues - $125 per new member per year. Payment may be submitted using the membership registration form.

*Dues are due by September 30, 2024 for the 2024-2025 academic year*. Once dues are paid, no refunds can be provided.
Parent's Name*

First NameLast Name
Parent E-mail Address*
example@example.com
Parent Contact Number
Format: (000) 000-0000.
Student Information

Please complete the following information for each student you are submitting a registration.
Student 1
Student 2
Student 3
Student 4
Please list any food allergies or medical conditions we should be aware of.

New Member Registration

includes credit card transaction fees.

$127.00 Quantity

Total

$0.00

Credit Card

Billing Address

Street Address

Street Address Line 2

CityState

Zip Code
Permission Acknowledgement/Release of Liability Waiver

Each member is required to complete for participation in Pearland NSBE Jr.
I hereby give (student(s) named above) permission to become a member of the National Society of Black Engineers Jr. Pearland Chapter and NSBE for the 2024‐2025 year. In giving my permission to participate, I understand that he/she will take part in scheduled meetings, workshops, cultural, educational, and recreational programs. I agree to provide transportation for my child to all scheduled meetings and activities. I understand and agree that by completing this consent form, neither I nor my agent(s) will hold NSBE Jr Pearland, NSBE, chapter advisors or volunteers and those acting on its behalf, liable in the event of harm, injury, or death of the participating child whose name appears above.
I do hereby release, forever discharge and agree to hold harmless NSBE Jr Pearland or NSBE, chapter advisors or its Volunteers, and agents thereof from any and all liability, claims or demands for personal injury, sickness or death, as well as property damage and expenses, of any nature whatsoever which may be incurred by the undersigned and the participant that occur while said person is participating in any activity.
Yes, I agree and consentNo, I do not agree
Should be Empty:

NEW Member Registration Form

Student Information

Credit Card

Permission Acknowledgement/Release of Liability Waiver