Phi Theta Kappa
Member Information
Campus: ________________________
Last
Name_______________________________ First Name_________________________
Street
Address_____________________________________________________________
City_________________________________ State______ Zip
code_______________
Phone_________________________ Email____________________________________
DMACC ID
#___________________________ Today’s Date_______________
I am interested in:
Leadership Conference (
Making Posters/Flyers_______ Writing
News Blurbs for Banner______
Serving as a Chapter Officer______ Volunteering at
chapter events________
Helping with chapter
website_______ Scholarship
Information_____________
International Convention (April in
I have these ideas for our
chapter!
What are the BEST day(s) &
time(s) in your schedule for us to meet?