Promoting Excellence in the Alpha Omicron Chapter Profession of Counseling Stetson University 421 N. Woodland Avenue, Unit 8389, Deland, FL 32723 Executive Board Local Chapter Membership Renewal Form 2006-2007 Name: _______________________________________________________ Christopher Lawrence Mailing address: _______________________________________________ President ______________________________________________ Cynthia Grow Vice President Phone: (_____)____________ H (_____)____________ C Jessica Beebe Email: _______________________________________________________ Secretary Credit hours completed: _______ Major: ______________________ Cindee St. Pierre Treasurer Expected graduation date: _______________________________________ Anthony Thompson Dues Member at Large Yearly (August – July) eligibility requirements include the following: Paid membership in Chi Sigma Iota International ($35) David March, Paid membership in Chi Sigma Iota, Alpha Omicron chapter ($15) Ph.D. Minimum 3.5 cumulative GPA Faculty Advisor Participation in one (1) community service project 321-231-4053 Participation on one (1) committee Committees Please rank in order of interest (1 = highest, 5 = lowest): Membership and Alumni Relations _____ Professional Development _____ Communication _____ Practicum and Internship _____ Social Planning _____ Yearly dues requirement is $50 (described above) Total enclosed: $_____ (Membership dues and contributions are tax deductible in the U.S.) *Please make check payable to Chi Sigma Iota. **Complete this form by the end of the first week of the Fall or Spring semester and return with your check to: Dr. March, Donna Schick (DeLand), Mig Childs (Celebration), Cindee St. Pierre, or Cynthia Grow.
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