Name: ___________________ Date: _______________________
Address: _________________ Phone 1: ____________________
_________________________ Phone 2: ____________________
_________________________ E-mail: ______________________
May we place your e-mail on our Organization Distribution List?
___ Yes ___ No
May we place your phone number(s) on our Organization contact list?
___ Yes ___ No
What is your Class Ranking? __ Fr. __ So. __Jr. __ Sr. __________ other
Please list concerns, interests, or projects you would like
the DSO to consider:
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
____________________________________________________
MEMBERSHIP INTO THE DSO IS $20.00 PER ACADEMIC YEAR PAYABLE AT
THE START OF EACH FALL SEMESTER .
My signature below verifies I would like to become an active
member of the UNCP Disabled Student Organization and
agree to follow all by-laws of the group as outlined
with the Student Government Association and
the DSO Constitution.
Name:__________________________ Date: ______________
PLEASE RETURN THIS FORM ALONG WITH YOUR MEMBERSHIP DUES TO
Accessibility Resource Center, Oxendine Administrative Building, Room 110.
THANK YOU AND WELCOME TO DSO!