New initiate form

Kappa Tau Alpha
School of Journalism
University of Missouri
Columbia MO 65211-1200

Fed. ID #43-6037162

Tel: 573.882.7685
umcjourkta@missouri.edu

e.g. Frank Luther Mott Chapter
Type carefully. Names will appear on the membership certificates as they appear here. Indicate faculty (F) or Honorary (H). Other names are assumed to be students. Please put each name on a separate line and do not number them.
Provide above the name and address of the address to whom the shipment of certificates should be sent. Format: Name Address City, State, ZIP code
Top Scholar Award costs $0.
If you have additional Top Scholars, enter their names here. Any additional awards will cost $50 each.
Top Scholar Award costs $0.
If you have additional Top Scholars, enter their names here. Any additional awards will cost $50 each.
Top Scholar medals are included with the award.
Any additional medals for graduates and undergraduates are $10 each.
All honor cords are $10 each.
The initiation fee is $35 per person.
Indicate the number of initiates.
Indicate the number of initiates.
Indicate the number of initiates.
Indicate the number of initiates.
Indicate the number of initiates.
Indicate the number of initiates.
Indicate the number of initiates.
Indicate the number of initiates.
Make checks payable to Kappa Tau Alpha (Fed. ID #43-6037162). Student checks cannot be accepted. University checks can be sent in U.S. Mail.
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