Undergraduate MIP Manual (April 2019)
Section IV MIP Remittance Summary
Date: ________________ Chapter: ___________________________ Region: _______________________
Colle
ge/University: ________________________________________ Proposed Initiation Date: ______________________
Address: _________________________________________________
City/State/ZIP: ____________________________________________
New Membership Fees – Revised January 1, 2020 (See Initiation Fees – IV-7)
Number of Candidates
Membership Intake Fee ____
x $100.00 = ____________
Per Capita Tax ____ x $ 95.00
=
____________
COIP Contribution ____ x $ 100.00 = ____________
EAF Due
s ____ x $ 10.
00 = ____________
MAPP Insurance ____ x $ 5.00 = ____________
Standa
rd Badge (
Candidates only) ____ x $ 265.00 = ____________
Special
Jewelry Badge ____ x $ ______ =
____________
(requires a Special Jewelry Order Form – candidates only)
History Book – Priceless Pearls ____ x $ 50.00 = ____________
So Now You’
re Elected ____ x $ 10.
00 = ____________
Say No To Hazing (Anti-Hazing Handbook) ____ x $ 6.00 = ____________
Program Brochure ____ x $ 3.00 = ____________
Shipping & Handling Cost $ ____________
(add an additional $20.00 for International Shipping)
TOTAL $ _________________
Che
ck Number(s): __________ Check Amount(s): ________________
________________________________________ _______________________________________
Signature of Basileus Signature of Grammateus
_______________________________________
Signature of Graduate Advisor
Mailing Address for New Initiate Packets
1. Check figures above before submitting this form to
the Corporate Office.
2. Attach report(s) that cover check(s) amount equal to
this Remittance Summary and mail to the Corporate
Office.
3. Complete mailing address at the right for shipment of
new initiate packets; package requires a signature.
4. Forward one (1) copy to the Corporate Office and
retain a copy for the chapter files.
Graduate Advisor Name:
Address:
City/State/Zip:
Email:
Check address type: Business ____ or Home ____
IV-8
click to sign
signature
click to edit
click to sign
signature
click to edit
click to sign
signature
click to edit