SOUTHEASTERN LA UNIVERSITY

PHI BETA LAMBDA

Membership Application

 

Name

 

Last Name: _____________________________________

 

First Name: ____________________     Middle Initial:  ___

 

Your W#

 

 

 

Email Address

(if different from W#)

 

 

 

Current Address

 

Street:

City:

State:                                       Zip:

 

Permanent Address

(if different from above)

 

Street:

City:

State:                                       Zip:

 

Phone

 

Home:

Alternative:

 

Study

 

Major:

Concentration:

 

Graduation

 

Expected Date of Graduation: 

 

Classification

(Circle One)

 

Fr.    So.    Jr.    Sr.    Grad.         

 

Membership

 

__ New Member                      __ Current Member

 

 

Dues

 

$20 / annually  (payable to PBL)              

Payment submitted:  Yes ___       No ___

 

Meeting

 

Convenient Times for Meeting:

_ Day of the week:                                 _ Times:

 

 

Please, return the completed application to

Bobbie Gill Schnepf, M.B.A., CBUS#02   or   Minh Huynh, Ph.D., CBUS#45.

Or Drop it off at the Management Department Office (c/o Minh Huynh)