MEMBERSHIP REQUIREMENTS for LOCAL CHAPTERS

Region ____
LC CODE ___________________
Federation Year 2010-2011
Complete Name of Local Chapter:
Complete School Address:

Name of School Dean:

Mobile Phone No.
Landline No.
E-mail Address:

Name of JPIA Adviser:

Mobile Phone No.
Landline No.
E-mail Address:
Summary:
1st Year
2nd Year
3rd Year
4th Year
5th Year
Total Number of Members
[see attached member’s Profile in MS Excel format]

Membership #______________
Date of Membership

Certified by:

National Vice President for Membership

National Vice President for Finance