PETITION FOR NEW CHAPTER OR CHAPTER RE-AFFILIATION To Form A Chapter: 1. Have at least five student members and one sponsor wanting membership. 2. Provide letters of support from your department chair and from your college or university executive officer. 3. A copy of your communication activity budget from your business office. 4. Mail the completed petition form. 5. Once notified of approval send payment (one time charter fee $75; yearly chapter dues $50; yearly province dues $10, $15, or $20 depending on province). 6. Fill out and send in five individual membership cards plus the one time $35 initiation fee for each individual joining Pi Kappa Delta. ________________________________________________________________________________ Petition for New Chapter or Reaffiliation We, the undersigned, are applying for membership into Pi Kappa Delta as a (check one): ___ New Chapter ___ Reaffiliated Chapter from___________________________________________(official institution name) ___ New Alumni Chapter Faculty Advisor:__________________________ Position/Title:__________________ Department:_______________________________ Office Phone:____________________ Mailing Address:____________________________________________________________ E-mail:___________________________________ Fax Number:______________________ Communication Degree Program offered at Institution: ____Major ____Minor ____Masters ____Ph D If no major or minor, list courses offered which relate to communication/forensics/public speaking/oral interpretation, etc. on a separate sheet of paper. Forensic/Communication Activities (public, non-classroom, etc.) _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Do you anticipate a sustained commitment to your forensic/communication program at your institution? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Put the names of members as you wish them to appear on the charter (please type on a separate sheet). I certify that the above students have met all requirements for membership into Pi Kappa Delta, and are willing to uphold the ideals of this organization as stated in its Constitution. Advisor's Signature_______________________________________________ Mail Completed Form To: PI KAPPA DELTA National Headquarters 125 Watson Street P O Box 38 Ripon, WI 54971-0038 PKD Home