West Virginia University at Parkersburg
Phi Theta Kappa - Sigma Omega
Chapter Membership Form
Date: ______________________________ Paid: __________________
Phone: (home) ________________________________ (work) ____________________
Student ID number: ________________________________________
Date of graduation or transfer _________________ (if you’re not sure, give us your best guess)
Are in you interested in:
Becoming an enhanced member?____ yes _____ no _____ maybe later
Becoming a chapter officer?____ yes _____ no ____ maybe later
Serving as a committee chair for one or more activities? ____ yes ______no _____ maybe later
Participating in one or more chapter activities? ____ yes _____ no _____ maybe later
Which of these activities, if any, might you be interested in getting involved in?
_____ Scholarly activities
_____ service projects
_____ leadership projects
_____ chapter newsletter
_____ travel to regional and international meetings
_____ trying to win regional and international awards
What is your major? ____________________________________________
What is your status: (please check appropriate box and complete the following)
* First-time Member please return this form and your dues check ($70.00).
* Transferring Member please return this form and your dues check ($25.00)
*Make all checks payable to Phi Theta Kappa
* If you are mailing this form, mail it to Dianne Davis, West Virginia University at Parkersburg, 300 Campus Drive, Parkersburg, WV 26104.
If you have questions you can contact Erin Watkins on the main campus at 424-8213 or Violet Mosser at the Jackson County Center at 372-6992.
Thank you for joining Sigma Omega Chapter of Phi Theta Kappa.
Signature Required ________________________________ Date ________________
Payment by installment is available.