This form is to be completed at the beginning of the semester of the intended Graduation Date.
Name:___________________________________________________Membership
Graduation Date: _____________________________
Address after Graduation:
Employer/ Graduate School Information: Unknown [ ]
Alumni Membership Plans:
I Plan to Affiliate with the local Alumni Chapter in my Current/ New Area [ ]
(Please forward me contact information for Local Alumni Chapter [ ]) I Plan to affiliate with the General Organization as an At-Large Member [ ] I May be inactive at the Completion of Graduation [ ]
Signatures
Phone: 1.800.373.3089 | Fax: 301.206.9789 Page 1 of 1
Email: forms@apa1906.net