INTERNATIONAL MEMBER FORM


Do not use this form if you have been previously expelled from the fraternity!

(* denotes required)

Member ID (i.e. your 9-digit Control Number)

Chapter of Initiation *
Initiation Date *


Last Chapter of Affiliation

Please provide current address information below:

First Name * Middle Name Last Name *

Home Address * City * State * Zip *

Preferred Contact Number
* Home Phone Email *

INTERNATIONAL MEMBER DUES and OTHER FEES

QTY Unit Price Amount

International Member Dues $ $
Re-instatement Fee (if not financial for two or more years) $ $
Late Fee (if not currently financial and payment date is after December 31st) $ $
Life Membership (select quantity if you choose to apply) $ $
Partial Life Membership (select quantity if you choose to apply) $ $

GRAND TOTAL $

*** NOTE: Columns will not total until the "Calculate Total" button is selected below.

Online payment is highly recommended. If assistance is needed,
please contact the IHQ Membership Supervisor at 404-284-5533.