Print this form to mail along with chapter initiation fees or P.O. Number within two weeks of Initiation to: Kappa Omicron Nu
Name of Chapter:
Initiation Date:
Enclosed are:
No. of Membership Cards (one for each Initiate) OR Alternate Form (the alternate form should include name, maiden name if applicable, permanent [home] address, gender, graduation month/year, status [undergrad, graduate, professional] degree candidacy, and major.
No. of Initiation fees at $55.00 (2011-12)
Total Due:
Check is enclosed (payable to Kappa Omicron Nu). Enter Check Number. - OR -
Institution will send check. Enter P.O. Number.
Name of Administrator:
Signed:
Chapter Vice President:
Date:
Adviser:
Were CERTIFICATES for these initiates ordered in advance? If not, please submit an ORDER FORM indicating number needed.
Retain a copy of this report for your files.
Print and mail with the fees to the following address.
Kappa Omicron Nu, 4990 Northwind Drive, Suite 140, East Lansing, MI 48823-5031
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H O M E C O N T A C T K O N S I T E I N F O S I T E M A P
KAPPA OMICRON NU HONOR SOCIETY
