Alpha Mu Gamma
ORDER FORM
Prices effective until May 30, 2017
Charter/Membership FeesCHAPTER’S GREEK DESIGNATION/NAME:
Quantity / Cost / Total
National Dues for Full (Student) Member / $25.00
Certificate for Faculty / $5.00
Certificate for Associate / $2.00
Certificate for Honorary Member / $2.00
Accessories, etc.
J-100 / Pin(With a pin at the back) / $4.00
J-101 / Key (for pendants or bracelets) / $4.00
J-127 / AMG Honor Cords (Double) / **$10.00
Note: VP Gavel is on backorder.
Subtotal
**If ordered separately: $12 each, includes S&H by regular 1st Class Mail
Shipping and Handling, etc.
S&H for certificates & about 10 pins ONLY / $10.00
Extra $9.00 for anything in excess of the above
Contribution to AMG Scholarship Fund
Contribution to AMG Scholarship Fund
TOTAL REMITTED TO "ALPHA MU GAMMA NATIONAL"
Mailing Address
Advisor/
Sponsor / Chapter name
College: / Department
Street Address: / City:
State: / ZIP code:
Email: / Phone:
Instructions
BE SURE THAT YOU:
· Consulted the Fees & Price List
· TYPE out the names of initiates, language on the third page of this form OR on a separate document; and the date of initiation ceremony
· Included a brief sketch of the initiation ceremony and any other interesting chapter activity for inclusion in the next issue of AMG "Newsletter" in the Annual Chapter Report Form
· Sent a check to the TREASURER or the correct amount plus shipping & handling. Include a copy of your order.
Mail the check & copy of order form to:
Alpha Mu Gamma National Office
Department of Modern Languages and Literatures
Fairfield University
1073 North Benson Rd.
Fairfield, CT 06824
Please also EMAIL a copy of THIS FORM TO National headquarters for our records:
Orders will be mailed once payment is received.
FOR AMG OFFICE USE ONLY
Order arrived: / Check #:
Order Mailed / Amount received: / $
. Activity checked:
Note:
Date of Initiation Ceremony
Month: / Day: / Year:
List of New Members
First Name / Last Name / Language / Membership Type
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25
Languages use abbreviations: S=Spanish; Fr=French; G=German; It=Italian; R=Russian; AB=Arabic; Ch=Chinese; J=Japanese; L=Latin, Gr= Greek; P=Portuguese etc.
Type of Membership: F= Full, A= Associate; H= Honorary; Fac= Faculty