First Name:

Maiden Name:

Last Name:

c Miss

c Mrs.

c Ms.

c Dr.

Address:

This is the best phone number to reach me: (      ) 

this is my:

c Home

c Work

c Cell

Chapter:

University:

Month and date of birth:

c I am interested in serving as an advisor to the Epsilon Kappa chapter.

c I would like a list of undergraduate Kappas who are available to babysit.

c I am willing to host an event at my home.

c I am a 50, 65, or 75 year Kappa.

Let us know your contact preferences:

c I regularly check the following e-mail address ___________________________________

c I do NOT check my e-mail. Please send information to me through regular mail.

Suggestions/Comments:

c Regular Membership $35.00

c Student/50 year membership $20.00 (for grad students, 2005 grads, and 50+ year Kappas)

Make checks payable to:

KKG Columbia Alumnae Association

Please e-mail the Alumnae Association for the address to mail the form and your dues.