Change of Address Form and Interest Inventory

Current KON members may enter name and address changes below. Please be sure to include all relevant information, and check for accuracy before submitting. Members who are interested in committee or board duties may include that information below.

* required fields

My Chapter: *
Member number
(if known)
My Details (as listed in KON records):
Title       
First Name and Initial *  
Last Name *
Name Change:
(if applicable)
 
Permanent (Home) Address
Street: *
 
City: *
State: * (Select 'Non-US' if applicable)
Zip: *
Country and Region: (If non-US)
Permanent e-mail: *
**Important note about your email address: Your institution will disable your student email address after you graduate. Kappa Omicron Nu is better able to serve you after graduation if you provide your permanent, personal email address
 
Email Preferences
Email Publications Only
Email Invoices Only
Email All
Do Not Email
   

Kappa Omicron Nu
Interest Inventory

I am interested in:

an Appointed Committee
an Elected Committee
a Board Office

 


Comments:

 
Acknowledgement (required *):
I authorize KON to contact me to confirm the details given.

Enter 388267 here to continue:
  

 

Privacy: Kappa Omicron Nu does not share your personal details, including your email address, with any third party.

Print this form for your records.