Delta Omega Delta Alumnae Chapter

2017-18 Membership Form

Delta Omega Delta (DOD) membership benefits include newsletters,

networking opportunities and invitations to special DOD, EK and Alpha Chi events. Pay online
www.axo-dod.org

Levels of Membership
DOD annual dues cover national per capita dues, operating expenses, Convention/Province Day fees and provide
support for the Epsilon Kappa Chapter, the EK House Corporation, the National Fraternity and various Alpha Chi causes.

$0 2017 Epsilon Kappa Alumnae $45 Carnation Membership

$30 Young Alumnae (2012-2016) $ 75 Lyre Membership*
$30 Classic (50+ year members) $100 Hera Membership*
*A portion of the dues from Lyre & Hera Memberships will be distributed to the areas listed below. Please choose your gift designation:
EK House Corp. EK/Undergraduate Scholarship DOD/Graduate Scholarship Greatest Need

Member Information
I am a: New Member Returning Member

Im interested in... Hosting an event Board/Chair position

Name: (First) (Maiden) (Last)

Address:

City / State / Zip:

Phone: Email:

Im on Facebook LinkedIn Twitter @ _______________________ Instagram @ ________________________

Birthday: Chapter: School: Year of Initiation:

Payment
Send payment and completed form to: Delta Omega Delta, PO Box 4346, Fullerton, CA 92834 or pay online at axo-dod.org

Check enclosed (made payable to Delta Omega Delta)

Credit Card: AMEX Discover MasterCard Visa (Note: $2 credit card convenience fee will be added)
Card #:
Exp Date: CVV2/Security Code: (3-digit code on back of the card)
Name on Card: Signature:
Billing Address (if different from above):