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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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Copyright ©2007   AHEPA-Dist 4   All Rights Reserved
                            God Bless Us All !!!
This resource is provided by the generous support of the
                             " Sotolidis Family  "
           In Memory of their Departed Loved Ones !!!