Jacksonville Alumnae Panhellenic Membership Application
(Once completed, please be sure to hit "Submit" button at the bottom.)
Name: 
First
Last
Address: 
Street
State
City
ZIP
Sorority: 
College/University: 

Please make check payable to Jacksonville Alumnae Panhellenic Association and mail to: 

JAPA Treasurer
6749 Mopsy Lane
Jacksonville, FL 32210

Thank you for your interest and participation! 
If you have any questions about membership, please call Carol Taylor at 262-1892 or email at taylor1825@bellsouth.net.

Email address: 
Preferred method of contact:
Maiden
Number of years in JAPA
Spouse's Name: 
Home phone: 
Work phone: 
Occupation: 
Employer: 

Membership Dues:$25
Scholarship Donation:  $

in memory of
in honor of

Directory Ad: $
business card @ $10
1/2 page @ $20
full page @ $40
(Directory Chair will contact you regarding copy.)

Total JAPA Support:     $


Scholarship Fund Recognition Levels:

Supportive Sister$15 - $24

Generous Greek Giver$25 - $49

Panhellenic Patron     $50 - $74

Athena Society   $75 +

Birthdate:
Month
Day
New MemberRenewing Member
emailregular mail