IB 361
7/07
(PP,ES,Nat.IVP)
DELTA OMICRON
INTERNATIONAL MUSIC
FRATERNITY
Collegiate Chapter Roster
Twice each year, in
the fall and in the spring after
officers are elected, the chapter secretary prepares 3 COPIES and sends them to the Province President. Refer to chapter president's IB 351, check
list, for specific due dates.
DATE
_______________________________ CHAPTER
__________________________________________
SCHOOL
_____________________________ CITY/STATE
________________________________________
CHAPTER MEMBERSHIP
SUMMARY
Collegiate
Membership Fr___ Soph ___ Jr ___ Sr
___ Gr ____ Total ________
Prospective Members Fr___ Soph ___ Jr ___ Sr ___ Gr ____
Total ________ (Planned Initiation Date: ______)
SPRING TERM
ONLY: Total Membership Minus
Graduating Seniors: ___________________
HEAD OF
DEPARTMENT Mr. Ms. Mrs. Dr.
__________________________________________________
Title (eg, Dean,
Chair, etc.) ________________ Dept. Phone ( )__________________________________
CHAPTER ADVISER
_______________________________________________________________________
Address
_____________________________________________________ Phone(
)__________________
E-Mail
______________________________________________________ FAX ( ) ___________________
FACULTY SPONSOR
_____________________________________________ Member of DO SAI
MPE PMA ?
School Address
________________________________________________ Phone(
)_________________
Home Address
________________________________________________ Phone(
)_________________
E Mail
______________________________________________________ FAX (
)__________________
President ___________________________________________ Email
________________________________
Fr. So. School Address
_________________________________ Phone (
) __________________________
Jr. Sr.
Gr. Home Address _________________________________ Phone (
) __________________________
Summer Email
_________________________________ Cell
Phone ( ) ______________________
I Vice Pres. __________________________________________ Email
________________________________
Fr. So. School Address
_________________________________ Phone ( ) __________________________
Jr. Sr.
Gr. Home Address _________________________________ Phone (
) __________________________
II Vice Pres. __________________________________________ Email
________________________________
Fr. So. School Address
_________________________________ Phone (
) ___________________________
Jr. Sr.
Gr. Home Address _________________________________ Phone (
) __________________________
Secretary ___________________________________________
Email ________________________________
Fr. So. School Address
_________________________________ Phone (
) ___________________________
Jr. Sr.
Gr. Home Address _________________________________ Phone (
) ___________________________
Treasurer ___________________________________________ Email
________________________________
Fr. So. School Address
_________________________________ Phone (
) ___________________________
Jr. Sr.
Gr. Home Address _________________________________ Phone (
) __________________________
Music Activities
______________________________________ Email
________________________________
Fr. So. School Address
_________________________________ Phone (
) __________________________
Jr. Sr.
Gr. Home Address _________________________________ Phone (
) __________________________
Publicity ____________________________________________ Email
________________________________
Fr. So. School Address
_________________________________ Phone (
) __________________________
Jr. Sr.
Gr. Home Address _________________________________ Phone (
) __________________________
Warden ____________________________________________
Email _________________________________
Fr. So. School Address
_________________________________ Phone (
) __________________________
Jr. Sr.
Gr. Home Address _________________________________ Phone (
) __________________________
Historian ____________________________________________
Email ________________________________
Fr. So. School Address
_________________________________ Phone (
) __________________________
Jr. Sr.
Gr. Home Address _________________________________ Phone (
) __________________________
Chaplain
___________________________________________ Email
________________________________
Fr. So. School Address
_________________________________ Phone (
) __________________________
Jr. Sr.
Gr. Home Address _________________________________ Phone (
) __________________________
Rush Chair
_________________________________________ Email
________________________________
Fr. So. School Address
_________________________________ Phone (
) __________________________
Jr. Sr.
Gr. Home Address _________________________________ Phone (
) __________________________
Scholarship Chair
____________________________________ Email
________________________________
Fr. So. School Address
_________________________________ Phone (
) ___________________________
Jr. Sr.
Gr. Home Address _________________________________ Phone (
) ___________________________
** Please attach a list or spreadsheet
of all other officers and members to this form. Include addresses and phone number for all members.