Alpha Kappa Alpha Sorority, Inc. ®
Remittance of Per Capita Tax Form
Chapter name: _______________________________ Region: ______________________________ Location: _____________________
Basileus: ______________________________________
Address: ______________________________________ City: __________________________________ State:______________ ZIP: ___________
Graduate Advisor: ____________________________________
Address: ______________________________________ City: __________________________________ State:______________ ZIP: ___________
Per capita with EAF for renewing member:
Undergraduate $110.00
Graduate: $135.00
Late Fine after February 1:
Undergraduate $9.50
Graduate $12.50
Name submitting report:
__________________________________
Chapter position:
____________________________________
Address: ______________________________________
City: __________________________________
State:______________ ZIP: ___________
Phone: ________ - __________ - ____________
Email:__________________________________________
Date paid: ___________________
Chapter tax: $ __________________________ (must include with first submission)
Per capita tax: $ ________________________
Late fine: $____________________________
*15% Administrative fee: $_________________________
*This fee is assessed ONLY to the total amount of the above for chapters submitting payment by
mail*
Total submitted: $______________________________ Check no: __________________________
