FLX REGISTRATION INFORMATION
What is FLX? The Fall Leadership Extravaganza (FLX) focuses on chapter success, personal
leadership, and etiquette training for members and advisors of Nevada DECA, FBLA, and HOSA.
It is the “must attend” state experience of the fall! Meet your State Officers! Discover the
benefits of your membership! Prepare for the best year ever!
When and Where
HOSA FLX – RENO
October 19, 2012
University of Nevada – School of Medicine
10:00 a.m. – 2:30 p.m.
HOSA/FBLA/DECA FLX – LAS VEGAS
October 22, 2012
Cashman Center
8:00 a.m. – 3:00 p.m.
Registration Deadline All registration forms (Forms 1-4) must be received by 4:00pm on
October 12. Registrations will not be accepted after this date. Registration forms should be
submitted via email to: [email protected]
Advisors should keep all other forms (Forms 5-6) in their possession during the conference.
Eligibility Training designed exclusively for members, chapter officers, and advisors of DECA,
FBLA, and HOSA.
Registration Fee The registration fee is $45, which includes a one-day event with leadership
training, etiquette training, and lunch. NO PURCHASE ORDERS please.
Refund Policy There are NO REFUNDS. Substitutions are accepted. Any student(s) who drops
after the registration deadline must still pay registration fees. The chapter is ultimately
responsible for all registration payments.
Change Deadline & Change Fee All changes/updates/corrections to registration after October
12, 2012 will incur a $10.00 change fee. These charges are automatically applied through the
registration system. No cancellations are allowed after October 12, 2012 at 4:00 p.m. Although
cancellations are not permitted, substitutions are accepted.
Substitutions Substitutions are accepted. Please submit changes/substitutions via email to
[email protected]. Name changes after October 12, 2012 or on-site will be
accepted with a $10.00.
Payment
Please make checks payable to:
Please mail checks to:
Nevada HOSA
Nevada HOSA
PO Box 912, Jacksonville, OR 97530
Nevada Fall Leadership Extravaganza 2012
HOSA Registration Guide and Forms
Page 1
FLX REGISTRATION CHECKLIST
SEND TO: [email protected]
DESCRIPTION
Registration Summary
Attendees List
Statement of Assurance
Service for Special Needs
Students (if applicable)
DEADLINE
October 12
Send via email
October 12
Send via email
October 12
Send via email
or FAX to 702939-9058
October 12
Send via email
FORM
1
COMPLETE
2
3
4
MAIL TO: Nevada HOSA, P.O. Box 912, Jacksonville, OR 97530
DESCRIPTION
Check made payable to:
Nevada HOSA
DEADLINE
October 18
FORM
N/A
COMPLETE
BRING TO THE CONFERENCE: Keep in your possession throughout duration of
conference
DESCRIPTION
Medical Release Form
Student Code of Conduct
DEADLINE
Bring to
conference
Bring to
conference
FORM
5
COMPLETE
6
TIMELINE
Today!
October 12
October 18
October 19
October 22
Make Appropriate Arrangements with School Administrators
Share Event Information with Chapter Members
Make Appropriate Travel Arrangements
Registration Deadline for Fall Conferences
Payment due to State Offices in Jacksonville, OR
Enjoy a spectacular event in Reno at the School of Medicine!
Enjoy a spectacular event in Las Vegas at the Cashman Center!
Nevada Fall Leadership Extravaganza 2012
HOSA Registration Guide and Forms
Page 2
TENTATIVE AGENDA
RENO – October 19, 2012 (HOSA ONLY)
9:30 – 10:00 a.m.
10:00 – 10:20 a.m.
Registration
Welcome Session
10:20 – 11:05 a.m.
Leadership Training Sessions
11:15 a.m. – 12:00 p.m.
Leadership Training Sessions
12:00 – 1:10 p.m.
Dining Etiquette/Networking Session/Lunch
1:10 – 2:10 p.m.
Association Specific Training
2:10 – 2:30 p.m.
Closing Session/Adjourn
LAS VEGAS – October 22, 2012
8:00 – 8:30 a.m.
Registration
8:30 – 8:50 a.m.
Welcome Session
8:50 – 9:20 a.m.
Keynote Speaker
9:30 – 10:15 a.m.
Leadership Training Sessions
10:25 – 11:10 a.m.
Leadership Training Sessions
11:20 – 11:50 p.m.
Dining Etiquette and Networking Session
11:50 – 12:35 p.m.
Lunch
12:45 – 2:25 p.m.
Association Specific Training
2:30 – 2:50 p.m.
Closing Session/Adjourn
CONFERENCE SPONSORS
The Nevada Fall Leadership Extravaganza events are produced by: Nevada DECA, Nevada HOSA,
and Nevada FBLA-PBL and supported by the Nevada Department of Education and TRI
Leadership Resources.
Nevada Fall Leadership Extravaganza 2012
HOSA Registration Guide and Forms
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NEVADA STATE LEADERS
Nevada DECA State Officers
Front Row (L-R): Cassandra Taylor (Southern Nevada Vice President), Daniela Sanchez (President), and Desiree
Tolentino (Vice President of Membership) Back Row (L-R): Valerie Cana (Vice President of Publicity), Ikya Kandula
(Northern Nevada Vice President), and Helena Lagos (Secretary).
Nevada FBLA State Officers
Front Row (L-R): Sawyer Eisaman (Northern Region VP), Bianca Cseke (Southern Region VP), Flora Shi (VP Service),
Rose Yi (VP Public Relations), Courtenay Collins (Eastern Region VP) Back Row (L-R): Wesley Ott (VP Media), Sam
Yoon (VP Membership), Jennifer Tang (President), Matthew Edgington (National Western Region VP, Executive VP).
Nevada HOSA State Officers
(L-R): Jae Song (Post Secondary Vice President), Bserat Ghebremicael (Secretary)
Jenny Ha (President), Hanna Eason (1st Vice President), Henry Teng (2nd Vice President)
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HOSA Registration Guide and Forms
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CONFERENCE POLICIES
The Code of Conduct is strictly enforced. Only participants registered for the conference may
enter the conference facilities.
Anyone not registered for the conference may not attend or participate.
Students may not “come and go” during the duration of the event. Students may not leave
conference facilities without the permission of their advisor.
DECA, HOSA, and FBLA-PBL require that all attendees be accompanied by a school approved
chaperone who is responsible to ensure all students are supervised and participating fully in the
education and leadership activities. Registration materials will only be given to the chaperone.
Attire
Professional business attire is required for the Leadership Extravaganzas. Please consult attire
guidelines for your association when determining what to wear for the Extravaganza.
CONFERENCE CONDUCT
DECA, FBLA, and HOSA have proud traditions of excellence! Our members are noted for their
professionalism, hospitality, and manners. The very nature of these leadership events demand
that all delegates conduct themselves as true "professional student leaders." DECA, FBLA, and
HOSA have established guidelines for both dress and conduct that contribute to the learning
experience. All delegates must understand that though having a good time is definitely
encouraged, expectations are high and violations of accepted principles will not be tolerated.
Conduct Enforcement
Chapter advisors are primarily responsible for enforcing all conduct activities for his/her
chapter members. Staff is available to assist advisors, when necessary, in the enforcement of
conduct guidelines.
DECA, FBLA, and HOSA advisors work together to make sure the delegation adheres to
accepted guidelines. All students need to understand that any advisor's request for improved
behavior must be followed. Advisors are encouraged to act on all transgressions by any
delegates and to be sure that the delegate's local chapter advisor is made fully aware of the
violation.
Participation
All delegates are expected to participate 100% in the conference. This includes attending all
general sessions, meetings, and workshops. It is not appropriate for members to be simply
“hanging out” during leadership and workshop sessions. It is also important for participants to
display excellent standards of professionalism and demeanor. Talking during sessions, refusing
to participate, or disrupting sessions with distracting behavior is not a sign of a professional
future leader.
Nevada Fall Leadership Extravaganza 2012
HOSA Registration Guide and Forms
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Cell Phones
Students should be strongly encouraged to TURN OFF their cell phones during the hours of the
conference. Cell phones on vibrate or silent mode will be accepted as long as they are not
distracting. AT NO TIME is it appropriate for members to get up and leave a session to take a
call. It is very disruptive to participants and rude to presenters when members and advisors are
accepting phone calls and removing themselves from participation to accept outside calls and
pages.
ADVISOR DUTIES/RESPONSIBILITIES
As leaders and teachers of young professionals, it is important that we prepare our students for
the events to come. The following information will help you to plan for the Fall Leadership
Extravaganza and prepare your students with important information about the conference. We
anticipate a significant number of state business partners or potential partners to be attending
and volunteering at the conference. Our members, or in other words, our product, will be on
“display” at all hours. Please keep this in mind when determining who represents your chapter.
Special Needs Students
The State Management Team makes every attempt to accommodate special needs students at
the conference. If you contact us prior to the conference, we can make the conference and
competition as barrier free as possible. If you have students with physical challenges or other
special needs that make movement or participation in the conference more difficult, please be
sure to complete the “Special Needs Form” and submit it along with your State Registration
Materials by the registration deadline outlined in this packet.
Standards of Behavior
A concern at any student conference is the standard of conduct. FLX is no exception. The state
staff has worked hard to let the convention teams know how important their role is in making
our conference a success, so the image students and advisors make during this conference is
vital. Our members exhibiting a business-like image to the conference staff, guests, and judges,
are extremely important.
Visibility
Drop in and check on your students. Performing a "head count" from time to time is important,
but be sure to physically see every student during the conference. Ask questions about events
and have a conversation with them so you can see how they are doing. With all of this, you will
know that your students have been accounted for which helps prevent challenges.
Meet challenges head-on in a positive manner! Do not let things get out of hand – do your
part, tactfully. Ask other advisors for ideas if you are not sure how to handle minor
situations.
Nevada Fall Leadership Extravaganza 2012
HOSA Registration Guide and Forms
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AVOID COMMON REGISTRATION FRUSTRATIONS
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Type information requested in the registration materials to assure accuracy of name
tags, etc. This will save you time at registration! Be sure to use both capital and
lowercase letters (do not enter names in all capitals)
Follow-up with the district or business office to make sure the check will be received on
time.
Do not FAX your materials! The only acceptable way to register for the Extravaganzas is
e-mail ([email protected]). The only registration piece allowed by FAX is the
Statement of Assurance.
Photocopy all forms and correspondence for your records.
Bring a copy of all school forms and conference registration records with you to
conference.
Write your chapter’s name on the top of each form. This will reduce mix-ups and
delayed registration. Do not abbreviate your high school name.
Get the CELL PHONE numbers of every participant attending from your chapter!
Invite your school administration officials to showcase DECA, FBLA and HOSA!
Make registration checks payable to: Nevada HOSA.
Nevada Fall Leadership Extravaganza 2012
HOSA Registration Guide and Forms
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REGISTRATION FORM – FORM 1
Complete the following information to register your chapter for the 2012 Fall Leadership Extravaganza.
1. Please type all information and email the completed form no later than 4:00 p.m. on Friday,
October 12 to [email protected].
2. Please make check payable to Nevada HOSA and send with a copy of this form to be received by
October 18 to: Nevada HOSA, PO Box 912, Jacksonville OR 97530
Payment should be mailed directly to the Finance Office with a copy of Form I no later than Friday,
October 18, 2012. Late fees will be assessed on all registrations submitted after October 12 or payments
received after October 18, 2012.
School:
Organization:
Advisor Name:
HOSA
Daytime Phone:
Email:
Which Extravaganza will you attend?
(Mark one)
Reno (10/19)
Las Vegas (10/22)
# Students Attending Extravaganza
x $45 =
# Adults Attending Extravaganza
x $45 =
Late Fees ($10/person after 10/12/2012)
x $10 =
TOTAL DUE:
$
If applicable, anticipated grant funds for this event:
$
Nevada Fall Leadership Extravaganza 2012
HOSA Registration Guide and Forms
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REGISTRATION FORM – FORM 2
School:
Advisor Name:
Organization:
City
(Mark your FLX)
HOSA
Reno (10/19)
Las Vegas (10/22)
Name
Status
List as it should appear on their name badge
Advisor/Chaperone/Student
Use a second sheet if needed. Please number pages.
Nevada Fall Leadership Extravaganza 2012
HOSA Registration Guide and Forms
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STATEMENT OF ASSURANCE – FORM 3
Advisors attending the Fall Leadership Extravaganza events must review, sign, and return this
statement of assurance along with their registration materials for each HOSA conference/event.
Nevada Fall Leadership Extravaganza
As the advisor responsible for the students attending this event I confirm that:
 I have reviewed the Permission/Medical Release Form with my students and I will have
a completed copy of the Permission/Medical Release Form for each student attending in
my possession for the duration of the above event, including travel to and from this
event.
 I understand that Nevada HOSA will not collect the individual student forms for this
event and that they are to be kept in my possession.
 I understand that students attending the above event may have the opportunity to
participate in activities outside of the conference facility, thus requiring walking or
further public transportation. I have discussed this with the students and their
parents/guardians and have also informed them of proper etiquette and safety
precautions while traveling in/around metropolitan areas.
 I understand that proper completion of the permission/medical release form provides
the best protection for my students’ needs and my liability during a Nevada HOSA event.
 I have checked with my administrator and have secured authorization for my chapter to
travel to this event and have reviewed all school/district policies regarding supervision
of students on trips and will abide by them.
 Nevada HOSA requires a chaperone to student ratio of 1:15 at all events.
 The responsibility for the safety of the delegates from this chapter rests with people
signing this Statement of Assurance.
 I will participate in all general sessions during the conference and fulfill my assigned
responsibilities during the conference.
 I will enforce the conference Code of Conduct and Dress Code, and regularly check-in
with my students.
 I will ensure that myself and chaperones assisting me will:
o Be 21 or older
o Follow the conference Code of Conduct and Dress Code
o Act responsibly and interact appropriately with students
I have read the above and hereby offer assurance that I understand and agree to comply with
the policies stated on the Permission Forms as indicated by my signature appearing below.
(Typing/writing your name in the box below serves as your signature and confirmation of understanding):
Advisor
Signature:
Chapter Name:
Date:
Nevada Fall Leadership Extravaganza 2012
HOSA Registration Guide and Forms
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SERVICE FOR SPECIAL NEEDS STUDENTS – FORM 4
If you have a student who has special learning or other special needs please indicate those
needs here. Please fill in the information as completely as possible to help us provide a positive
learning experience for all of our conference participants.
Student Name:
Chapter:
Event Name:
Special Needs Condition:
Service Requested:
Please mail form by October 12 to:
Nevada HOSA
P.O. Box 912
Jacksonville, OR 97530
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HOSA Registration Guide and Forms
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MEDICAL RELEASE FORM – FORM 5
Event Name and Date
NEVADA HOSA FALL LEADERSHIP EXTRAVAGANZA
Student Name
Date
Home Address
City
Home Phone
Zip Code
Cell Phone
High School
Date of Birth
School Phone
State Advisor
AGREEMENT
This is to certify that the above named student has my permission to attend the HOSA conference or event listed above. I also do
hereby, on behalf of the above named student, absolve and release the school officials, the HOSA chapter advisors, and the HOSA
staff from any claims for personal injuries which might be sustained while he/she is in route to and from or during the event.
I authorize the above named HOSA advisor(s) or HOSA staff to secure the services of a doctor or hospital. I will incur the expenses
for necessary services in the event of accident or illness and provide for the payment of these costs.
I have read and agree to abide by the Nevada HOSA Conduct Code. I also agree that the school officials, the HOSA chapter
advisers, HOSA staff, or the Conference Conduct Committee, have the right to send the above named student home from the
activity at my expense, provided that in their opinion the seriousness of a Conduct Code violation warrants it.
MEDICAL INFORMATION
Known Allergies (drug or natural)
Special Medications Being Taken
History of heart condition, diabetes, asthma, epilepsy, etc.
Date of last tetanus shot
Any physical restrictions
Personal Doctor
Doctor Phone
INSURANCE INFORMATION
Insurance Company
Policy Number
Coverage and Limitations
SIGNATURES
Student Signature
Date
Parent or Guardian Signature (required for any member under age 18)
Date
State Advisor Signature
Date
Chapter Advisor Signature
Date
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HOSA Registration Guide and Forms
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MARC
STUDENT CODE OF CONDUCT – FORM 6
A good reputation enables us to take pride in our organization. As a participant at Nevada
HOSA functions, you represent the whole organization. Nevada HOSA members have an
excellent reputation of standards to uphold. Your conduct at any HOSA function must enhance
the reputation that has already been established by Nevada HOSA. Please carefully read the
following conduct code agreement and sign below.
1. I understand that my behavior at all times should be such that it reflects credit to my school
and the organization. I agree to respect the rights of others in relation to myself, my
manners, noise, language, and general conduct.
2. I agree to attend all competitive events business meetings, workshops and other scheduled
activities on time and well prepared.
3. I agree to report any accidents, injuries, or illnesses to a Nevada HOSA designee
immediately.
4. I agree to observe the designated curfew. (Curfew is described as being in your own
assigned room and quiet by the designated hour.)
5. I agree not to deface or vandalize property, public or private, and understand that I will
have to pay for any damages incurred by myself.
6. I agree not to purchase, consume or be under the influence of alcohol or drugs at any
Nevada HOSA activity. No alcoholic beverages or non-prescribed drugs (including tobacco)
shall be in the possession or consumed at any time while representing the Nevada HOSA
organization.
7. I agree to dress neatly and appropriately for the occasion. I will be in professional HOSA
attire for all meetings. (See specifics on conference dress code page).
8. I agree to be honest and not to take unfair advantage of others.
9. I understand that if I disregard the rules I will be subject to disciplinary action and will be
asked to return home at my own expense.
I have read the above Conduct Code rules and agree to abide by them.
Name (Print)
Signature
Date
Parent/Guardian (Print)
Signature
Date
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HOSA Registration Guide and Forms
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