Text form

Zeta number _______

Name _____________________________________________________________________

Address ___________________________________________________________________

City, state, ZIP ______________________________________________________________

Phone _________________________________

E-mail ____________________________________________________________________

Initiation year ______________________ Years at ASU ___________________________

Enclosed:

Alumni dues for 2008-09: $50 _____

If a graduate in 2004 or later: $25 _____

House Corp. contribution: $________

50th anniversary Founders Day contribution $ ____________

Note: Every brother who makes a Founders Day contribution of $25 above the dues level will receive a commemorative T-shirt; for those who make a contribution of $50 or above the dues level, a commemorative polo shirt; for those who make a contribution of $75 or more above the dues level, choice of commemorative polo shirt or denim shirt. Be sure to check the Founders Day line, and make choice below.

$25 contribution: T-shirt size _________ Or cap (adjustable) _____

$50 contribution: Polo:Light blue ___ Stone ___ White ___ Size ______________

$75 contribution: Denim shirt: Size ___________

(Make checks payable to Iota Theta House Corp.)

Signed by _____________________________________________________

_____ I’ll be there for the 50th Anniversary Founders Day. Keep me informed.

Mail to:

Roy Ockert, Treasurer

LXA House Corp.

2815 Spring Valley Drive

Jonesboro, Ark. 72404