Yes! I'll help build the new chapter house

1.  I will be come a partner in the Epsilon-Sigma in the Bond Partnership at the level marked below

2.  I can't participate as an In the Bond Partner, but I'll help with the enclosed contribution for 

$ _______  (I understand for a contribution of $50 or more, my name will be included on the contributor plaque)

Your Name ___________________________________________ Chapter __________Scroll #____________

Your Address ___________________________________ City ____________________Zip___________________

Email _____________________________ Day Phone _________________ Evenings_______________

Type of Payment     ____Bank Draft   ____Visa   ____ MasterCard ___ Check For Balance Enclosed ______

Account # ____________________________  Credit Card Exp. Date. ____________

Signature ______________________________________________

(If Bank Draft  please enclose a voided check along with your down payment.  Also complete the information below for the bank draft)

Name of Bank_____________________________________  Location (city & state)________________________

PRINT THIS & MAIL TO:  Epsilon-Sigma of TKE In The Bond Partnership , PO Box 4092, Edmond, OK 73083-4092  or call Roger Pugh at 405/373-1313 or 405/478-1125