PTK Membership Form Spring 2024

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Welcome to Phi Theta Kappa,

We hope you are doing well and excited about your semester with Phi Theta Kappa.

Please fill out this membership application completely and pay your membership dues by following the instructions within your membership section (New, Returning, or Transferring).

Thank you and have a wonderful semester.

If you have any questions, please email Mary Kohls, your Phi Theta Kappa Advisor at kohls@austincc.edu and Carol Ann Hernandez, Phi Theta Kappa Liaison at carol.hernandez@austincc.edu, or call (512) 223-3185.

Last Name *

First Name *

Middle Initial (If none, please leave blank.)

Austin Community College Student ID # *

House or Apartment Address (Number/Street Only) *

Apartment, unit number, or N/A? *

City *

State (Two letter abbreviation) *

Zip Code *

ACC Student Email Address *

Phone Number: (example: 5122233185) *

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