CANDIDATE APPLICATION

The Delta Theta Phi Law Fraternity, International

*All information should be typed or printed legibly: your name as written in full below is as it will appear on your certificate unless you otherwise specify.
* Each candidate for membership shall complete this application. The original should be completed and returned to the Senate office/officers.

Name in Full: _____________________________________________________________________________

FIRST
MIDDLE
LAST
___________________________________
Law School Name

Ryan Senate
_________________________________
Senate Name

______/______/_______
Date of Birth (MM/YY)

______________________
Anticipated Yr. of Graduation

SENATE USE:
____/____/______
Date of Initiation

OFFICE USE

Permanent Street Address: ________________________________________________________________

City, State, Zip: ___________________________________________________________________________

Member Number

__________

E-mail Address (non-school address preferred): ________________________________________________

Senate Number

Would you prefer to receive our quarterly newsletter, The Paperbook, electronically? (circle one) YES

_____ Fee Recd?

NO

Current Phone Number1: _(______)________________________ Is this cell?____ or home?_____

Current Phone Number2: _(______)________________________ Is this cell?____ or home?_____

Name/Relationship/Phone of One Character Reference: _________________________________________________________________________

Name of Any Other Law School Attended, if any: _______________________________________________________________________________
Name of Undergraduate School attended: _____________________________________________________________________________
* Check with local officers on the amount of fees due in addition to the International Fee of $70. The portion submitted to the Office is nonrefundable. No person may be initiated until the International Fee has been paid in full. Returned checks will be charged a $20 service fee.
The Senate shall keep a copy of the application for its records, and in turn forward the original application and appropriate fees to: Laurie
Vesalo, Executive Administrator, Delta Theta Phi Law Fraternity, Intl, Campbell University Wiggins School of Law, 225 Hillsborough St, Ste 410,
Raleigh, NC 27603
You should remit the applications and fees within ten days of the initiation ceremony. Please allow 4-6 weeks from receipt for certificates to be sent
to senate.
I SOLEMNLY AFFIRM that I am not a member of any other law fraternity, and that the above information is true. I further promise
that if accepted as a member, I will be initiated and pay all fees. I subscribe to the objects and purposes of The Delta Theta Phi Law
Fraternity, and I will support the Constitution of the Fraternity and the decisions and edicts of the International and Supreme Senates.
Date: _______________________

_____________________________________________
Signature

CERTIFICATION OF THE DEAN OR TRIBUNE

I CERTIFY that the candidate has signed this application, is qualified for membership, has received the required approval of our
senate, and has been initiated.
Date: _______________________

_____________________________________________
Dean or Tribunes Signature

Last Updated: 06/12