Chapter # District # Located in (City): State:
Prefix (Mr./Dr.) Last Name Suffix (DDS, Esq)
First Name Nickname Middle Initial
Address
City State Province Country
Homephone - Workphone
FAX - Email
Date of Birth Are You a Citizen of the US or Canada
Yes No
Were You a Member Of The Sons of Pericles? If Yes,
Chapter,City, State
FOR REINSTATEMENT ONLY Serial Number Date Initiated
I Hereby Apply For Reinstatement Of My
AHEPA Membership Into Chapter #
I Was Previously a Member of Chapter # , Location
I Hereby Certify That I Have Paid My Dues Up To (Date) To
Chapter
--------------------------------------------------------------------------------
FOR MEMBERSHIP TRANSFER ONLY Serial Number Date
Initiated
I Hereby Apply For Transfer of My AHEPA Membership from
Chapter # Located in
To Chapter # Located in
I Hereby Certify That I Have Paid My Dues Up To (Date) 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.
Signature , Date
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