ALPHA PHI ALPHA FRATERNITY , INC. ® | 9050 JUNCTION DRIVE, ANNAPOLIS JUNCTION, MD 20701Chapter Affidavit of Rejection

Date:

In accordance with the vote of the members of Chapter, Key____ Aspirant: ID# did not receive the appropriate percentage of votes and is hereby by denied membership into Alpha Phi Alpha Fraternity, Inc. at this time.

The following is given as the reasoning for rejection:

Aspirant was not rejected by chapter but did not attend the Leadership weekend activities.

I have read and agree to the terms of the above statement.

Chapter President Date

Chapter Name Key Number

Please Return To: Alpha Phi Alpha Fraternity, Inc.Membership Support Services9050 Junction DriveAnnapolis Junction, MD 20701

Fax to: (301) 206-9789Email: forms@apa1906.net

***A reason for rejection must be provided in order to process the refund***

REFUND OF INTAKE FEES Yes

Aspirant Name: Aspirant ID: Mailing Address where refund should be forwarded: Contact Information: (Cell) (Home) (E-Mail)

Phone: 1.800.373.3089 Page 1 of 1Email: forms@apa1906.net document.doc