Chapter Membership Order Form

Fill out the below form to order your new membership certificates and membership jewelry. 

Orders should be submitted two weeks prior to your initiation date in order to ensure timely delivery.

Please note that fields marked with an asterisk (*) are required.

*Name of your institution, as it should appear on the certificates:
 

*Your chapter's initiation date:
This is the date that will be printed on the certificates.  If you need to receive the certificates before a certain date, please include that in the list below.
              ,             

*Shipping address:
 

*E-mail address:               

*Number of students invited to join ALD:  
*Number of new dues-paying student members:  
Number of new honorary members:
Number of new free student members:
Number of lapel pins requested:
Number of insignia key charms requested:

*List of new student/honorary/free members:
Using the copy/paste function, please paste your list of new initiates into the text box below.  The names should be formatted in standard format, with each name on a separate line: 
        John Smith
        Mary Jackson
        Patrick J. Marks
        Kelly Marie Doe

        NOT:
        Smith, John
        MARY JACKSON
        Patrick J Marks
        Kelly    Marie    Doe

DO NOT USE TABS IN THIS LIST.  Use normal spaces only.

 

Please make sure you have completed all fields before clicking "Submit."  Fields marked with * are required.

PLEASE NOTE: Once you click "Submit," your order will be sent to National ALD.  Please do NOT click "Back" or attempt to resubmit your report after clicking "Submit" once, unless you receive a specific error message.  If you do receive an error message, please send a copy of that message to Lee Greenway (lee@nationalald.org).