CJ Information
CJ Degree Info
         

Alpha Phi Sigma (AΦΣ)
Eta Theta Chapter

Membership Application




Please fill out the following form, and then continue through the payment process.

Note: During the payment process, Enter your IRN Number in the Customer ID field. Also, use the same email address used in your membership application.

The information you provide on this form will be used on your membership certificate, official records, and subscriptions. Please be sure to use your permanent (or home) address if you currently have a temporary student address.

 

Chapter Name: 

Eta Theta

 

 

Chapter Induction Fee: 

$65.00

Total Amount Due: 

$65.00

 **The amount above will cover your membership packet (certificate and membership card).**

Membership Information


First Name:Middle Initial:Last Name:

IRN Number:

Address:

City:

State/Province:

ZIP/Postal Code:

Country:

Phone Number:

Fax Number:

Email Address:

Questions/Comments:

 

 

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