Membership Application Download the PDF application here to submit via email or physical mail. Membership Application Phi Beta Kappa Alpha Association of Colorado PO Box 9476 • Denver, CO 80209 Website: pbkcolorado.org • Email: email@example.com Title Name * Address * Apt/Unit # City * State * Zipcode * Phone * Other Phone Email * Major/Degree * Year Initiated to ΦΒΚ * College/University * Profession / Area of Interest * Our membership list is only used for the purposes of the association; it will not be shared with any outside organization, and it may not be used for commercial or political solicitations. Membership Level * Half of your dues will be allotted to the Members’ Endowment to support our scholarship program. New Graduate — One-year free membership for PBK initiates who graduated in the last 12 months Sustaining Membership @ $30.00 per year Contributing Membership @ $100.00 per year Life Membership @ $500.00 (one-time payment) Committees I am interested in serving on the following committees: Finance Scholarship Membership Programs Publicity Alpha Networking Additional Donation Please consider making an additional donation to support our scholarship program or members’ endowment. If you use PayPal, please tell us in the message box how you want your donation applied. Your donations are tax-deductible to the extent the law allows. Scholarship Fund Endowment Fund Donation amount $25 $50 $75 $100 Other amount: Other Amount Please keep my donation anonymous Please mail your dues check payable to Phi Beta Kappa, Alpha Association of Colorado to the address above. If you use PayPal, make your payment to firstname.lastname@example.org. Thank you! Submit If you are human, leave this field blank.