AHEPA: District 11

APPLICATION FOR MEMBERSHIP
(Complete this form to receive full membership information from District 11 of the AHEPA family organization. Membership is limited to U.S. and Canadian citizens, or those residing in U.S. and Canada and intending to become citizens.)

Mail To:

Please Check one:
AHEPA (men's organization)
Daughters of Penelope (women's auxiliary)
Son's of Pericles (young men's auxiliary, ages 14-27)
Maids of Athena (young women's auxiliary, ages 14-27)

Subject:

E-mail address:
Full name:

Address:
City:

State:
Province:

Zip-Code:
Country:

Home Phone:
Fax:

Profession:
Company/Organization:

Work Address:
City:

State:
Province:

Zip-Code:
Country:

Work Phone:
Date Of Birth:

Gender: Male Female

What activities would interest you

Would you like to participate in any of the following committees:

Social Fundraising Educational Athletics Charity Other

Please send us your comments using the following area:

E-mail address:	Full name:
Address:	City:
State:	Province:
Zip-Code:	Country:
Home Phone:	Fax:
Profession:	Company/Organization:
Work Address:	City:
State:	Province:
Zip-Code:	Country:
Work Phone:	Date Of Birth:
Gender: Male Female