Status Form to Fill out:

Please fill this out.  This form temporarily must be printed out and handed to the treasurer signed.  Once the website is transferred this form will automatically be sent to the treasurer.  Please be adviced that this is a binding contract, so please retain a copy for your records.

I Here by declare myself as Active Inactive Conditional Membership Candidate for the Fall Spring 1999 2000 2001 2002 2003 2004 2005 Semester.  If I am Active or Conditional I Agree to pay the dues required of me by the chapter according to the constitution of our chapter.  If I am Inactive I will agree to pay as I go for food and or costs associated with an activity as I am INACTIVE.  If I am a Membership Candidate I will also pay the amount as stated in our constituion by the date set by the Membership Educator and treasurer.  I also understand that this form is a binding contract and When it is sent I agree to the above information.  I will also print myself out a copy unless a copy is requested to the treasurer in which case I will get a copy of this form.  For Now I will print this form out and give it to the tresurer as this form will become electronic by November 1999

Signed:____________________________________   Date: January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1999 2000 2001 2002 2003 2004 2005