IB 367.1

7/07

(PP)

DELTA OMICRON

INTERNATIONAL MUSIC FRATERNITY

Report of Bank Account

Complete and send this report to the Province President with the first financial report in the fall.

CHAPTER _______________________ Province ___________________ Date _____________

Kind of Account ____________________ Account Number ___________________________

Name and Location of Bank _____________________________________________________

______________________________________________________

Those authorized to sign (Title only; i.e. Treasurer, President, Chapter Adviser or Faculty Sponsor.)

____________________________________________________________________________

Report of Scholarship Account (If your chapter has one)

Kind of Account _____________________Account Number ___________________________

Name and Location of Bank______________________________________________________

Those authorized to sign (Title only, i.e., Treasurer, President, Chapter Adviser or Faculty Sponsor)

____________________________________________________________________________

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FOR COLLEGIATE CHAPTERS ONLY - Report of Chapter Membership Loan Fund

Amount on Hand in the Fund __________________________________________________________

Amount on Loan __________________________________________________________

Name of Bank Where Fund is Deposited ________________________________________________

Location of Bank ___________________________________________________________________

Type of Account ___________________________________________________________________

Account Number ___________________________________________________________________

_____________________________________ ______________________________________

Chapter President Chapter Adviser