DEPARTMENT OF HISTORY
AMERICAN UNIVERSITY
AU
PHI ALPHA THETA
APPLICATION FOR LIFE TIME MEMBERSHIP
1.  Please fill out the following information:  

Name:

Local Address:

Local Phone:

E-Mail:

Permanent Address:

 

2.  Complete and send this form, together with a copy of your transcript and a check for $60.00 (payable to PHI ALPHA THETA) to the Department of History, 137 Battelle-Tompkins, American University, 4400 Massachusetts Avenue, NW, Washington, D.C. 20016-0038

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