Membership Form - Beta Phi Mu
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1Membership Form
Directions: Complete and return this form, along with your check in the amount
of $85.00 made payable to Beta Phi Mu, to your local chapter.
(Please type or print your name as you would like it to appear on your certificate.)
Name
First
Middle Name or Initial
Last
Mailing Address
City
State
Zip Code
Email Address
Phone Number ___________________________
Permanent Address
(if different from above)
City
State
Zip Code
Position Title
Workplace
Library School Attended
Year Graduated__________
Chapter Affiliation __________________________________
Date of Initiation _________
Please check all that apply:
□
□
Lifetime Membership Fee Enclosed
I would like to be inducted in absentia
For Chapter Use Only
I hereby certify the above named candidate’s eligibility for membership into Beta Phi MU.
____________________________________
__________________________________
Chapter Secretary, Signature
Chapter Secretary, Name (Print)
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