Membership Registration Form

Nu Phi Omicron, Inc. Member Registration Form

First name

Last name

Email

Phone

Birthday

Month

Day

Year

Occupation

Multi-line address

Country/Region

Address

Address - line 2

City

Zip / Postal code

High School Name

High School City & State

High School Graduation Year

College/University Name

College Graduation Year

Does your college/university have a N Phi O chapter?

Yes

Yes, but it's inactive

My school never had a chapter

I never went to a college/university

Were you initiated outside of your college/university chapter?

Yes

No

I never went to a college/university

Select your chapter:

Season you were initiated:

Year you were initiated:

Current member status:

Your Dean of Pledges full name:

Product

New Initiate: One-time payment for new initiates$100

Current College/University Student$75

Alumni/Non-College Student$100

Honorary Member: One-time payment$300

Lifetime Member: One-time payment$500

Do you have any gifts, talents or ideas you would like to see or bring to Nu Phi Omicron?

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Upload a preferred headshot for your Member ID card