Alpha Phi Alumnae of Northern Virginia Membership Form First Name Maiden Name Last Name Address City, State, Zip Preferred Phone Number Email Occupation/Employer Birthday College Chapter (spell out – e.g., Theta Iota)

Initiation & Graduation Years Twitter Handle Instagram User Name New Member

yes

Would you like to receive a print version (instead of email version) of our newsletter?

yes

DUES Please select ONE of the following dues types: Local Dues

$40.00

Recent Graduates (within the past 2 years)

$20.00

50+ Year Members

$25.00

Voluntary additional support of the local chapter, if you wish:

ΑΦ Silver & Bordeaux Member TOTAL

Amount at your discretion $

By December 1, please submit: Membership form: Email your new or updated membership form to [email protected] or if your information has not changed from last year, please simply send an email stating no change. Dues: May be paid either online at http://www.alphaphi-va.org/dues.asp or by check made payable to: Alpha Phi Alumnae of Northern Virginia in care of Lyndsay Kelsey, 4327 Ravensworth Road #512, Annandale, VA 22003

2015-2016 Alpha Phi Membership Form.pdf

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