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DELTA OMICRON INTERNATIONAL MUSIC FRATERNITY Change of Address and Information Form We are interested in knowing about YOU -- where you are, your professional work, awards, honors, other activities, and your family. Please send us information about yourself on this form, or directly to Whistle Editor, Lani Yearicks, at armytbonegirl@homtail.com. Please send any change of address information to: Julie Hensley Wright, Executive Secretary, P.O. Box 752, Jefferson City, TN 37760 FAX: (865) 475-9716 Email: DOExecSec@aol.com Date: _____________________ Name: (First)____________________(Maiden/Middle)__________________(Last)________________________ Current Address: Street/Apt# ___________________________________________________________________ City, State, Zip ______________________________________________________________________________ Telephone Number: (_____)_____________________ Email: ________________________________________ Former Address: (Street/Apt #) _________________________________________________________________ City, State, Zip ______________________________________________________________________________ Chapter into which you were initiated________________________________________ Date:________________ Are you currently a member of: Collegiate Chapter? yes______ no______ Name of Chapter_____________________________ Alumni Chapter? yes______ no______ Name of Chapter_____________________________ Alumni Club? yes______ no______ Name of Club________________________________ If no, are you interested in joining an Alumni chapter/club? yes_______ no_________ Please list your recent professional activities, work related information, honors, awards, and other information. ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ ______________________________________________________________________________________ For additional space, continue on back of page. THANK YOU! |