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Pi Kappa Phi Fraternity

Shingle and Member Card Order Form

Chapter:* School:*      
         
First Name* Last Name:* Position:*
     
Shipping Address 1:* Apt:*(if applicable) Phone:*
    (xxx-xxx-xxxx)
Shipping Address 2: Email:*    
         
City:* State:* Zip: *    
         

Membership Shingles

 
 
  First Name  Last Name  
     
     
     
     
     

Member Cards

 
  First Name  Last Name  
     
     
     
     
     

Order Summary

 
         
Amount of Membership Shingles Ordered: x $10.00 Each = 
Amount of Member Cards Ordered: x $4.00 Each = 
               
  Total Due:            

Payment Options are Below:

A staff member will contact you for payment options. 

 

Return Information 

Return To: Pi Kappa Phi (Attn: Kate Andrews)
At: 2015 Ayrsley Town Blvd. Suite 200
Charlotte, NC 28224
(980) 318-5321 | Fax (980) 318-5295
kandrews@pikapp.org | www.pikapp.org