ALPHA PI MU INITIATION REPORT
Certificate No.
INSTRUCTIONS:
PREPARE THIS REPORT IN DUPLICATE – RETAIN ONE COPY FOR CHAPTER
RECORDS AND SEND ONE COPY TO THE NATIONAL OFFICE
PREPARE TWO COMPLETED MEMBERSHIP CARDS FOR EACH INITIATE –
RETAIN ONE COPY FOR CHAPTER RECORDS AND SEND ONE COPY TO
THE NATIONAL OFFICE
SUBMIT A SINGLE DUES CHECK TOTALLING $45 FOR EACH INITIATE
THIS REPORT IS DUE AT LEAST THREE WEEKS PRIOR TO THE INITIATION
Chapter Date of Initiation
Seniors - Number in Class:
NAME - (As it should appear on the certificate)
First Middle Last
Juniors - Number in Class:
NAME - (As it should appear on the certificate)
First Middle Last
INITIATION REPORT (continued)
GRADUATE STUDENTS or ALUMNI
NAME - (As it should appear on the certificate)
First Middle Last
The above listed graduate students or alumni are recommended by me as qualified
candidates for membership in Alpha Pi Mu.
Name of Department Chairman Signature of Department Chairman
HONORARY MEMBERSHIP
Must be approved by national executive council (See national procedures manual)
NAME - (As it should appear on the certificate)
First Middle Last
FACULTY MEMBERSHIP
The faculty member must have been previously approved by the national executive
council (See national procedures manual)
NAME - (As it should appear on the certificate)
First Middle Last
Name of Faculty Advisor Signature of Faculty Advisor
Name of Secretary Signature of Secretary
(Must Contain All Signatures to be Valid)