Phi Beta Kappa Confirmation

Alpha of North Carolina Phi Beta Kappa Acceptance Confirmation
This form is required of all students who received an invitation to join the Alpha of North Carolina Chapter of Phi Beta Kappa at the University of North Carolina at Chapel Hill and have registered and paid their membership dues online.

Please fill out each section carefully and submit this form only once. If you have questions, please contact Jason Clemmons at jason@unc.edu.
Name (as you would like it to appear on your certificate and in any news releases)*

First NameMiddle NameLast NameSuffix
PID*
E-mail*
Initiation Ceremony
This semester's initiation ceremony is scheduled to be held in person on Monday, November 3rd at 5:30 p.m. in the Frank Porter Graham Student Union Auditorium.
Will you be attending the initiation ceremony on November 3*

YesNo
How many guests will you invite to attend (max of 2 due to seating limits)? *
If you think it will help our presenters, please indicate the pronunciation of your name
Membership and Key Options
Your membership on the Phi Beta Kappa national website will remain in "PENDING" status until the date of our induction ceremony, after which our staff will officially confirm your membership. You then will have full access to the site including the PBK store where you will be able to purchase merchandise such as the Phi Beta Kappa key.

If you are interested in having us order a key for you in advance and having it for you at the ceremony, please complete the section below.
Optional key order:

Sml Gold Electroplated Key = $40.00Med Gold Electroplated Key = $42.00Lrg Gold Electroplated Key = $44.00Sml 10K Gold Key = $240.00Med 10K Gold Key = $300.00Lrg 10K Gold Key = $470.00
Payment for key orders must be dropped off in person at 225 Graham Memorial during one of the following payment windows:
- Mon, Sept 8...10am-11:30am
- Thu, Sept 11...10:30am-12pm
- Tue, Sept 16...10am-12pm
- Mon, Sept 22...9am-1pm
We are able to accept the following forms of payment for key purchases:
- CASH (correct change only)
- CHECK/MONEY ORDER MADE OUT TO "PHI BETA KAPPA"
Information for News Services
The information below will be used by UNC News Services for an official press release. Soon after the induction ceremony, the release will be sent to all North Carolina media outlets and will appear as a news item on UNC web sites.
Class Year*
Primary major (no concentrations, please)*
Second major (no concentrations, please)
Minor 1
Minor 2
Hometown (how you want us to list where you're from in the news release)*

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Hometown County (NC Only)
Should be Empty:

Alpha of North Carolina Phi Beta Kappa Acceptance Confirmation

Initiation Ceremony

Membership and Key Options

Information for News Services