Date ___________                                                  Invoice / order #:__________________

                                                                                                                (to be filled in by National Office)

Member Induction and Honor Cord Order Form

Ship to:                      

(name)   

(address)

 Order completed by: (name)                                                                Phone #:

Chapter Name:   Lambda Pi Eta Chapter at The University of North Carolina at Wilmington

School Name:

                           The University of North Carolina at Wilmington

Initiation date of students:

                                            (standard form, example: August 24, 1998)

Name will appear on the certificates exactly as typed below.

         First name                           Middle Name or Initial                        Last Name

Gold, or red and white combination 60” braided cord with tassels

Quantity (#):     Gold                               Red and White

Make copies of this form as necessary.  Return order with $38 check payable to (announced each semester) to an LPE officer or to:

• Professor David Bollinger, Faculty Advisor
• Department of Communication Studies
• The University of North Carolina at Wilmington
• 601 South College Road
• Wilmington, NC  28403-5933

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