Membership Report
An Individual Pink Petition for Membership MUST be completed for EACH NEW MEMBER and submitted via mail to the National Office.

Annual Dues must also be submitted (mailed) to the National Office and are as follows:
Chapter Dues -- $100 per year
New Member Dues -- $50 per initiate
Returning Member Dues -- $15 per member

Petitions for Membership will not be processed until dues have been received.

This report is due by December 31, for FALL INITIATES and May 31, for SPRING INITIATES.

**NOTE**
Due to the diversity of our chapters, portions of this form may not apply to your local chapter (e.g. you do not have returning members). If this is the case, please scroll to the bottom of the page and select CONTINUE. Similarly, our chapters initiate anywhere from 5-100+ members at a time. Space is provided for the maximum number of new members. When you have entered the information for each of your new members, please scroll to the bottom of the following pages and select CONTINUE. We thank you for your understanding.

Chapter Institution
Your answer
Chapter Mailing Address
If you use a PO Box, please also include a street mailing address (e.g. 1234 Main Street, Our Town, ST, Zip)
Your answer
Sponsor Name
Your answer
Date of Initiation for New Member
MM
/
DD
/
YYYY
Number of New Members
(Returning Member Member Dues are $15/member)
Your answer
Number of Returning Members
(Returning Member Member Dues are $15/member)
Your answer
Total Amount of Dues Submitted to National Office
Please send a check to the National Office including Chapter Dues ($100 per year), New Member Dues, & Returning Member Dues
Your answer
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