Membership Application Pay Membership Dues I hereby wish to: (Check one only) Join as a new member into:Reinstate into:Transfer into: Chapter # District # City (State/Prov.) Prefix (Mr./Dr.) Last Name First Name Address City State/Prov Zip Country Phone Email Date of Birth Are you a citizen of the United States or Canada? YesNo Were you a member of the Sons of Pericles? NoYes Chapter # City & State/Prov FOR REINSTATEMENT ONLY Membership # Date Initiated I hereby apply for reinstatement of my AHEPA membership into Chapter # I was previously a member of Chapter # located in I hereby certify that I have paid my dues up to to Chapter # FOR MEMBERSHIP TRANSFER ONLY Membership # Date Initiated I hereby wish to transfer my AHEPA membership from Chapter # located in To Chapter # located in I hereby certify that I have paid my dues up to to Chapter # I believe myself worthy of the rights and privileges enjoyed by the members of AHEPA. I know no reason why I should not become a member, and I promise, if accepted, to observe the laws and traditions of AHEPA, and will not take advantage of or abuse my privileges as a member thereof. I believe in the divinity of Jesus Christ. Initials Date Pay Membership Dues