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Enrollment Information




Sending as a gift from:
Promotional Code / Referred By:
Personal Information

First Name: *
Middle Name:
Last Name: *
Preferred Name: *
Name as it will appear on membership card: *

School or Chapter:
Initiation Year:

Home Address: *
 
City: *
State: *
Zip Code: *
Email Address: *
Home Phone: *
Business Phone:
Payment Information

I wish to pay by:
Type of Card: *
Name as it appears on Card: *
Card Number
16 digits (15 for Amex) with no spaces *
Expiration Month: *
  
Zip Code: *
Name On Check *
Routing Number *
Account Number *
Re-enter Account Number: *

(It may take a moment to process this form. Please be patient.)

A payment receipt will be sent to the email address listed above for payments made via credit or debit card upon transaction authorization.



Besides making a one-time payment above, there is one other way you can obtain Loyal Order membership. You may sign up for the Forever KA program. Your first 17 monthly contributions of $18.65 through the Forever KA program will be attributed to a Loyal Order membership. Your participation in that program will continue with a monthly donation of $18.65 to the Kappa Alpha Order Educational Foundation. Please check out www.foreverka.com to learn more about how and why you should become Forever KA. For a monthly payment option to join the Loyal Order, please visit the ForeverKA secure donations form provided by our data management and gift processing partner OmegaFi.

Note: The Loyal Order membership is not tax deductible as a charitable contribution.


Feel free to contact Becky Moore, at bmoore@ka-order.org with any questions about The Loyal Order Program.