Central Florida Phi Delta Theta Alumni Club

2011-2012 Membership Application

Name: ________________________________ Spouse's Name: _______________________

Address: _____________________________ Home Phone: __________________________

City/State/Zip Code: _________________ Office Phone: ________________________

Occupation: __________________________ FAX #: _______________________________
            (generic description)

University/College: __________________ Class Year: __________________________
                   (Undergrad only)       (when you were supposed to graduate)

E-Mail Address: ______________________

Enclosed is my check for $40 to cover my dues for the year beginning September 2011 and ending August 2012. (First time members who are recent college graduates can join for $30.)

Please send this form and check to:
 

If you have any questions, call Greg at (407) 273-0938 or e-mail me at GregRhodes@email.com