Dear Brother or Sister,
The undersigned has been regularly balloted for and found worthy of becoming a Brother/Sister of the Psi Omega Fraternity. The applicant trusts that there is nothing upon the records that will deter him/her from such honors; and hereby agrees that if he/she is admitted into the Fraternity, he/she will abide by the Constitution and Ritual of the order, the By-laws of the Chapter, and the rulings of the National Council. The applicant respectfully petitions a writ of dispensation empowering the President to confer on him/her the Active Degree of this Fraternity.
Membership Form:
Select Your School's Chapter
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Alpha - University of Maryland
Beta Delta - University of California, San Francisco
Delta Psi - Baylor College of Dentistry
Delta Upsilon - University of Texas, Houston
Epsilon - Case Western Reserve
Epsilon Pi - Texas Tech University, El Paso
Gamma Gamma - University of Florida
Gamma Omicron - Medical College of Virginia
Lambda Alpha - UCLA School of Dentistry
Nu Sigma - NOVA Southeastern University
Omicron - University of Louisville
Phi Rho - University of Missouri, Kansas City
Psi - Ohio State University
Psi Gamma - University of Tennessee
Sigma Chi - Medical College of South Carolina
Sigma Iota - Southern Illinois University
Upsilon - University of Southern California
Upsilon Nu - University of Nevada, Las Vegas
Xi - Marquette University
Zeta - University of Pennsylvania
Zeta Kappa - University of Minnesota
Name
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First Name
Middle Name
Last Name
Graduation Year
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Year
Non-School (Personal) E-mail
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School E-mail
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Personal Cell Phone Number
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Area Code
Phone Number
I, the undersigned, in signing this pledge of Psi Omega Fraternity and if initiated into this fraternity, do bind and obligate myself never to become a member of any other Greek Letter Dental Fraternity. I understand that this pledge indicates my choice of dental fraternity, but it does not affect my attitude toward or prevent my association with members of other fraternities. I accept this pledge and these obligations fully realizing the consequences and importance of this act and in proof thereof affix my signature.
Applicant Signature
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$75 One-Time Initiation Fee
Psi Omega is a National Fraternity. Each local chapter of Psi Omega is supported by the National Chapter of Psi Omega Dental Fraternity. Any applicant wishing to join a local chapter of Psi Omega must also join the National Chapter of Psi Omega, and once accepted by the National Chapter, the applicant remains a life-long member of both the local and National Chapters of Psi Omega. A one-time initiation fee of $75 for membership in the National Chapter of Psi Omega will be charged to and collected from the local chapter after this application has been fully completed, signed and submitted. The $75 fee is collected from the applicant by the local chapter (and therefore cannot be paid while submitting this application).
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