Reinstated Member Form

Instructions:

Chapter Treasurer: Please send this form to your state treasurer immediately.

Members reinstated on or after July 1 and before April 1 will pay dues and scholarship fee at the time of reinstatement. Members reinstated on or after April 1 and before July 1 shall pay dues and scholarship fee for the ensuing year no later than October 31.

Mrs. Miss Ms. Dr.

First Name	Middle		Last
Mailing Address
City	State/Province/Country		Zip/Postal Code
Date of birth		Approximate year entered teaching
Present Chapter (Greek name)		State (geographic name)
Former Chapter (Greek name)		State (geographic name)

Degrees held: Bachelor Master Doctor Other: ______________

Date of Initiation:

Date of Reinstatement:

Membership Status: Active Reserve

Chapter Treasurer