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Omega Psi Phi Fraternity, Inc. - State of Mississippi Life Membership Application & Plaque Order
State life membership is $400.00 and may be paid by one installment of $400.00. The applicant will NOT be considered to be a life member of the State of Mississippi until such a time as the dues are paid in full. Furthermore, State Life members must maintain appropriate International, District and Chapter dues in order to be considered to be financial. All payments must be made via the dues portal by the chapter KRS. This form will be electronically submitted to the State of Mississippi KRS for processing.
**Once the member is a State Life member, he should still be reported via the District/State Dues portal with a zero-payment made.
**If this is a new plaque application,
DO NOT SUBMIT PAYMENT.
**
General Information
Please enter your name (below) as you wish it to appear on your State Life Membership Certificate.
Control Number
*
Prefix
First Name
*
Middle Initial
Last Name
*
Suffix
How do you want your name to appear on plaque
*
Contact and Mailing Information
Street Address
*
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
*
Phone (Main)
*
Email Address
*
Chapter Information
Chapter Name
*
Beta Alpha – Jackson, MS
Beta Rho – Itta Bena, MS
Beta Theta – Mississippi Valley State University
Eta – Alcorn State University
Eta Tau - Port Gibson, MS
Eta Xi – Starkville, MS
Eta Zeta – The University of Mississippi
Epsilon Kappa Kappa – Canton, MS
Iota Omicron – Clarksdale, MS
Iota Upsilon – Gulfport, MS
Kappa Beta – Rust College
Kappa Mu Mu – Greenville, MS
Mu Lambda Lambda – Tunica, MS
Nu Eta – The University of Southern Mississippi
Nu Mu Mu – Oxford, MS
Nu Xi – Natchez, MS
Omega Mu Mu - Tupelo, MS
Psi Gamma Gamma – Columbus, MS
Phi Rho – Hattiesburg, MS
Psi Mu Mu – Olive Branch, MS
Psi Rho – Holly Springs, MS
Rho Alpha Alpha – Cleveland, MS
Rho Epsilon – Tougaloo College
Sigma Alpha Alpha – Moss Point, MS
Theta Delta Delta – Mississippi State University
Theta Iota Iota – Meridian, MS
Upsilon Delta Delta – Delta State University
Upsilon Epsilon – Jackson State University
Xi Kappa Kappa – Yazoo City, MS
Other - Out of State Brother
New Plaque Orders ONLY
For current State of Mississippi Life Members only.
**Current State of Mississippi Life Members plaque prices is $60.00 + $10.00 processing fee.**
Are you a current life member?
Yes
No
What is your State of Mississippi Life Membership Number: (i.e. MS0000)
Would you like to purchase a State of Mississippi Life Membership Plaque?
Yes ($70.00)
No ($0.00)
If yes, how would you like for the name to appear on plaque?
**Please verify BEFORE you proceed.**
Have you verified ALL of the information above is correct?
*
Yes
No