Join or Renew Your Membership in
Phi Beta Kappa Association of Kentuckiana, Inc.

Please print the membership/renewal form below, fill in your information, and mail it with your check for $20 for annual dues (on an academic year beginning each September) payable to Phi Beta Kappa Association of Kentuckiana.  If you prefer, you can email your renewal information to linda.klein@kctcs.edu and bring a check for your dues payment to the next program.

Membership/Renewal Form
Phi Beta Kappa Association of Kentuckiana, Inc.

Please type or print:

Name ____________________________________   Phone ____________________

Address______________________________________________________________

City______________________________________, ST______   ZIP______________ 

Email:________________________________________________________________ 

If this is a new membership, please if possible provide your college and year of initiation into Phi Beta Kappa.  This will help match our records to the records of the national PBK Society when we submit our membership list.
College:___________________________________  Year ________   

Name at initiation if different ________________________________